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1.
Klin Mikrobiol Infekc Lek ; 26(1): 25-29, 2020 Mar.
Artigo em Tcheco | MEDLINE | ID: mdl-33326592

RESUMO

AIMS: To describe the symptoms and complications of influenza A in seniors in the 2018-2019 influenza season. MATERIAL AND METHODS: A retrospective analysis of data on 84 seniors with laboratory confirmed influenza A between 1 October 2018 and 30 April 2019 who were tested for this infectious disease in the University Hospital Pilsen. RESULTS: Influenza A was diagnosed in 84 seniors during the period under review. The most common symptoms were fever (69 cases; 82.14 %) and cough (60 cases; 71.43 %). These two symptoms combined occurred in more than half of patients over 65 years of age (51 cases; 60.71 %). Other common symptoms included general weakness (58 cases; 69.05 %) and fatigue (57 cases; 67.86 %). The other symptoms occurred in less than half of cases. The most common complication was pneumonia (36 cases; 42.86 %). Bacterial etiology was confirmed in 13 cases and the most commonly occurring pathogens were Klebsiella pneumoniae and Streptococcus pneumoniae. Another common complication of influenza was acute respiratory insufficiency in pneumonia, heart failure or exacerbation of chronic respiratory disease. The mortality rate of seniors in our sample was 17.86 % (15 cases). CONCLUSION: In the senior population, the most common symptoms of influenza are a rapid onset of fever and dry cough. The study has confirmed that the most common complication is pneumonia. Furthermore, exacerbations of various chronic diseases of the cardiovascular and respiratory systems, worsening of chronic renal insufficiency and urinary tract infections were common. The most effective prevention of the development of influenza and its complications is the available quadrivalent vaccine.


Assuntos
Influenza Humana , Pneumonia Bacteriana/complicações , Idoso , República Tcheca , Febre , Humanos , Influenza Humana/complicações , Influenza Humana/epidemiologia , Estudos Retrospectivos
3.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372021

RESUMO

Bilateral adrenal haemorrhage is a rare and often fatal condition that most commonly occurs under conditions of severe physiological stress. We describe a 33-year-old male patient with ulcerative colitis who presented with acute worsening epigastric pain, vomiting and raised inflammatory markers. Initial differentials included gastritis and peptic ulceration. Gastroscopy revealed no abnormalities. By day 3, he had developed sepsis with a sequential organ failure assessment score of 2 as well as coagulopathy. A subsequent CT scan diagnosed bilateral adrenal haemorrhage. A short Synacthen Test confirmed adrenal insufficiency and he was treated with replacement steroids and antibiotics for a possible urinary tract infection or pyelonephritis and he recovered well. Several days later he developed fever, dyspnoea and a productive cough. Subsequently, he became hypotensive (Blood Pressure (BP) 95/65 mm Hg) and unresponsive with a Glasgow Coma Scale of 7 and was hyponatraemic and hyperkalaemic. He was intubated and transferred to a tertiary hospital for intensive care unit management where investigations confirmed the patient to be influenza A positive.


Assuntos
Insuficiência Adrenal/etiologia , Infecções Bacterianas/complicações , Transtornos da Coagulação Sanguínea/complicações , Colite Ulcerativa/complicações , Hemorragia/etiologia , Influenza Humana/complicações , Sepse/complicações , Insuficiência Adrenal/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Coinfecção , Diagnóstico Diferencial , Hemorragia/complicações , Humanos , Hidrocortisona/uso terapêutico , Vírus da Influenza A , Masculino , Sepse/tratamento farmacológico , Tomografia Computadorizada por Raios X
4.
BMC Med ; 18(1): 403, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33334360

RESUMO

BACKGROUND: Due to the overlapping clinical features of coronavirus disease 2019 (COVID-19) and influenza, parallels are often drawn between the two diseases. Patients with pre-existing cardiovascular diseases (CVD) are at a higher risk for severe manifestations of both illnesses. Considering the high transmission rate of COVID-19 and with the seasonal influenza approaching in late 2020, the dual epidemics of COVID-19 and influenza pose serious cardiovascular implications. This review highlights the similarities and differences between influenza and COVID-19 and the potential risks associated with coincident pandemics. MAIN BODY: COVID-19 has a higher mortality compared to influenza with case fatality rate almost 15 times more than that of influenza. Additionally, a significantly increased risk of adverse outcomes has been noted in patients with CVD, with ~ 15 to 70% of COVID-19 related deaths having an underlying CVD. The critical care need have ranged from 5 to 79% of patients hospitalized due to COVID-19, a proportion substantially higher than with influenza. Similarly, the frequency of vascular thrombosis including deep venous thrombosis and pulmonary embolism is markedly higher in COVID-19 patients compared with influenza in which vascular complications are rarely seen. Unexpectedly, while peak influenza season is associated with increased cardiovascular hospitalizations, a decrease of ~ 50% in cardiovascular hospitalizations has been observed since the first diagnosed case of COVID-19, owing in part to deferred care. CONCLUSION: In the coming months, increasing efforts towards evaluating new interventions will be vital to curb COVID-19, especially as peak influenza season approaches. Currently, not enough data exist regarding co-infection of COVID-19 with influenza or how it would progress clinically, though it may cause a significant burden on an already struggling health care system. Until an effective COVID-19 vaccination is available, high coverage of influenza vaccination should be of utmost priority.


Assuntos
/epidemiologia , Doenças Cardiovasculares/epidemiologia , Coinfecção/epidemiologia , Influenza Humana/epidemiologia , Adulto , Doenças Cardiovasculares/complicações , Feminino , Humanos , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade
5.
Environ Health Perspect ; 128(12): 127004, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33325772

RESUMO

BACKGROUND: Environmental cadmium exposure is widespread. In humans, cadmium is poorly excreted, triggers pulmonary inflammation, reduces pulmonary function, and enhances lung injury by respiratory syncytial virus. OBJECTIVES: We examined the association of cadmium burden with mortality related to influenza or pneumonia. METHODS: This prospective analysis of the National Health and Nutrition Examination Survey (NHANES) included 7,173 and 8,678 participants ≥45 years of age enrolled in NHANES-III and NHANES 1999-2006, respectively. Associations were evaluated between cadmium and mortality from influenza or pneumonia during a median follow-up of 17.3 y (NHANES-III, based on creatinine-corrected urine cadmium) and 11.4 y (NHANES 1999-2006, based on blood cadmium). Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HRs) comparing the mortality of individuals at the 80th vs. the 20th percentile of cadmium concentrations. RESULTS: In NHANES-III, after adjustment for sex, race/ethnicity, education, body mass index, serum cholesterol, hypertension, and NHANES phase (or cycle), the HR comparing influenza or pneumonia mortality among participants with creatinine-corrected urinary cadmium in the 80th vs. 20th percentile was 1.15 (95% CI: 1.05, 1.26; p=0.002) in the population as a whole and 1.27 (95% CI: 1.12, 1.43; p=0.002) among never smokers. In NHANES 1999-2006, adjusted HRs for the 80th vs. 20th percentile of blood cadmium were 1.14 (95% CI: 0.96, 1.36; p=0.15) for the overall population and 1.71 (95% CI: 0.95, 3.09; p=0.07) in never smokers. DISCUSSION: Among middle-aged and older adults in the United States, higher cadmium burdens are associated with higher mortality from influenza or pneumonia. This raises the possibility that cadmium may worsen outcomes from COVID-19 infections. https://doi.org/10.1289/EHP7598.


Assuntos
/mortalidade , Cádmio/sangue , Poluentes Ambientais/sangue , Influenza Humana/mortalidade , Pneumonia/mortalidade , Idoso , Idoso de 80 Anos ou mais , /complicações , Exposição Ambiental , Feminino , Humanos , Influenza Humana/sangue , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Pneumonia/sangue , Pneumonia/complicações , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estados Unidos/epidemiologia
6.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318255

RESUMO

Influenza-associated encephalopathy/encephalitis (IAE) can result in serious neurological complications. We report a 4-year-old healthy female child with the diagnosis of IAE. Her clinical course was complicated by temporary visual impairment and significant motor deficits. Her unique ophthalmological findings have little precedent in previous literature.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/virologia , Influenza Humana/complicações , Transtornos da Visão/diagnóstico , Transtornos da Visão/virologia , Encéfalo/patologia , Encéfalo/virologia , Encefalopatias/fisiopatologia , Pré-Escolar , Feminino , Humanos , Vírus da Influenza B , Imagem por Ressonância Magnética , Transtornos da Visão/fisiopatologia
7.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370941

RESUMO

A 9-year-old girl was admitted to the paediatric intensive care unit with acute respiratory failure due to influenza. Nine months earlier, she presented with unexplained lymphoedema of the lower extremities and monocytopenia. She had a history of occasional finger warts and onychomycoses. During hospitalisation, the patient was diagnosed with Emberger syndrome caused by GATA2 deficiency. The admission was complicated by thromboses in the right hand, leading to amputation of multiple fingers. From then on, the patient has been in good recovery, the function of her right hand was improving and an allogeneic haematopoietic cell transplantation has now been successfully performed.


Assuntos
Dedos/patologia , Deficiência de GATA2/complicações , Fator de Transcrição GATA2/deficiência , Vírus da Influenza A/imunologia , /imunologia , Amputação , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Criança , Códon sem Sentido , Análise Mutacional de DNA , Quimioterapia Combinada , Feminino , Dedos/cirurgia , Deficiência de GATA2/diagnóstico , Deficiência de GATA2/genética , Deficiência de GATA2/imunologia , Fator de Transcrição GATA2/genética , Gangrena/imunologia , Gangrena/cirurgia , Glucocorticoides/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/imunologia , Influenza Humana/terapia , Influenza Humana/virologia , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Respiração Artificial , /terapia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
8.
Cephalalgia ; 40(13): 1406-1409, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33146034

RESUMO

New daily persistent headache was first documented in the medical literature in the 1980s. The leading trigger is a viral illness. As we navigate our way thru the current SARS-CoV-2 pandemic, looking back at past viral epidemics may help guide us for what to expect in the near future in regard to headaches as a persistent manifestation of the SARS-CoV-2 infection. The 1890 viral pandemic known as the "Russian or Asiatic flu", has extensive documentation about the neurologic sequelae that presented months to years after the pandemic ended. One of the complications was daily persistent headache. There are actually many similarities between the viral presentation of the 1890 pandemic and the current SARS-CoV-2 pandemic, which may then suggest that not only will NDPH be part of the neurological sequelae but a possible key consequence of the SARS-CoV-2 infection.


Assuntos
Infecções por Coronavirus/complicações , Cefaleia/epidemiologia , Cefaleia/virologia , Influenza Humana/complicações , Influenza Humana/história , Pneumonia Viral/complicações , Betacoronavirus , História do Século XIX , Humanos , Pandemias , Federação Russa
9.
BMC Infect Dis ; 20(1): 769, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076855

RESUMO

BACKGROUND: Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. METHODS: The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. RESULTS: In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. CONCLUSION: Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.


Assuntos
Hospitalização , Influenza Humana/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Cardiopatias/complicações , Hospitalização/estatística & dados numéricos , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Pneumopatias/complicações , Masculino , Noruega/epidemiologia , Razão de Chances , Cobertura de Condição Pré-Existente , Medição de Risco , Estações do Ano
10.
J Breath Res ; 15(1): 011001, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33089824

RESUMO

Infectious pathogens are a global issue. Global air travel offers an easy and fast opportunity not only for people but also for infectious diseases to spread around the world within a few days. Also, large public events facilitate increasing infection numbers. Therefore, rapid on-site screening for infected people is urgently needed. Due to the small size and easy handling, ion mobility spectrometry coupled with a multicapillary column (MCC-IMS) is a very promising, sensitive method for the on-site identification of infectious pathogens based on scents, representing volatile organic compounds (VOCs). The purpose of this study was to prospectively assess whether identification of Influenza-A-infection based on VOCs by MCC-IMS is possible in breath. Nasal breath was investigated in 24 consecutive persons with and without Influenza-A-infection by MCC-IMS. In 14 Influenza-A-infected patients, infection was proven by PCR of nasopharyngeal swabs. Four healthy staff members and six patients with negative PCR result served as controls. For picking up relevant VOCs in MCC-IMS spectra, software based on cluster analysis followed by multivariate statistical analysis was applied. With only four VOCs canonical discriminant analysis was able to distinguish Influenza-A-infected patients from those not infected with 100% sensitivity and 100% specificity. This present proof-of-concept-study yields encouraging results showing a rapid diagnosis of viral infections in nasal breath within 5 min by MCC-IMS. The next step is to validate the results with a greater number of patients with Influenza-A-infection as well as other viral diseases, especially COVID-19. Registration number at ClinicalTrials.gov NCT04282135.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Vírus da Influenza A/isolamento & purificação , Influenza Humana/diagnóstico , Pneumonia Viral/diagnóstico , Idoso , Testes Respiratórios , Infecções por Coronavirus/complicações , Análise Discriminante , Feminino , Humanos , Influenza Humana/complicações , Espectrometria de Mobilidade Iônica , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Estudos Prospectivos , Sensibilidade e Especificidade
11.
MMWR Morb Mortal Wkly Rep ; 69(42): 1528-1534, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33090987

RESUMO

Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, although increasing evidence indicates that infection with SARS-CoV-2, the virus that causes COVID-19, can affect multiple organ systems (1). Data that examine all in-hospital complications of COVID-19 and that compare these complications with those associated with other viral respiratory pathogens, such as influenza, are lacking. To assess complications of COVID-19 and influenza, electronic health records (EHRs) from 3,948 hospitalized patients with COVID-19 (March 1-May 31, 2020) and 5,453 hospitalized patients with influenza (October 1, 2018-February 1, 2020) from the national Veterans Health Administration (VHA), the largest integrated health care system in the United States,* were analyzed. Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, complications in patients with laboratory-confirmed COVID-19 were compared with those in patients with influenza. Risk ratios were calculated and adjusted for age, sex, race/ethnicity, and underlying medical conditions; proportions of complications were stratified among patients with COVID-19 by race/ethnicity. Patients with COVID-19 had almost 19 times the risk for acute respiratory distress syndrome (ARDS) than did patients with influenza, (adjusted risk ratio [aRR] = 18.60; 95% confidence interval [CI] = 12.40-28.00), and more than twice the risk for myocarditis (2.56; 1.17-5.59), deep vein thrombosis (2.81; 2.04-3.87), pulmonary embolism (2.10; 1.53-2.89), intracranial hemorrhage (2.85; 1.35-6.03), acute hepatitis/liver failure (3.13; 1.92-5.10), bacteremia (2.46; 1.91-3.18), and pressure ulcers (2.65; 2.14-3.27). The risks for exacerbations of asthma (0.27; 0.16-0.44) and chronic obstructive pulmonary disease (COPD) (0.37; 0.32-0.42) were lower among patients with COVID-19 than among those with influenza. The percentage of COVID-19 patients who died while hospitalized (21.0%) was more than five times that of influenza patients (3.8%), and the duration of hospitalization was almost three times longer for COVID-19 patients. Among patients with COVID-19, the risk for respiratory, neurologic, and renal complications, and sepsis was higher among non-Hispanic Black or African American (Black) patients, patients of other races, and Hispanic or Latino (Hispanic) patients compared with those in non-Hispanic White (White) patients, even after adjusting for age and underlying medical conditions. These findings highlight the higher risk for most complications associated with COVID-19 compared with influenza and might aid clinicians and researchers in recognizing, monitoring, and managing the spectrum of COVID-19 manifestations. The higher risk for certain complications among racial and ethnic minority patients provides further evidence that certain racial and ethnic minority groups are disproportionally affected by COVID-19 and that this disparity is not solely accounted for by age and underlying medical conditions.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Hospitalização , Influenza Humana/complicações , Influenza Humana/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Idoso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etnologia , Feminino , Disparidades nos Níveis de Saúde , Mortalidade Hospitalar/tendências , Humanos , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/virologia , Medição de Risco , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
12.
Medicine (Baltimore) ; 99(43): e22790, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120795

RESUMO

INTRODUCTION: Children with acute lymphoblastic leukemia (ALL) are at a risk of developing influenza-related complications. Approximately 10% of influenza-infected children with ALL or other types of cancer need intensive care, and 5% of them eventually die. PATIENTS' CONCERNS: We report 2 children with ALL and the swine-origin influenza A virus infection. Diagnosing influenza in them was a challenge. Medical records of these children were reviewed for demographic, clinical, and laboratory data. Patients were hospitalized in the Department of Pediatric Hematology, Oncology, and Transplantology of the Medical University of Lublin, Poland. Case 1 involved a 2-year-old girl who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2009, started chemotherapy in July 2015. She was categorized in the intermediate risk group and received the induction and consolidation phase of the therapy without severe complications. The reinduction therapy was administered in the outpatient department till the 15 day. On the 20 day of this phase, she was admitted to our department with fever, mucositis, tachypnea, abdominal pain, and diarrhea. In September 2009, a 14-year-old boy (case 2) who, according to acute lymphoblastic leukemia intercontinental Berlin-Frankfürt-Münster protocol 2002, was categorized in the high-risk (HR) group, received the induction (Protocol I) phase of therapy without severe complications. On the 7 day of the HR-1 course, he manifested fever and strong, tiring cough, followed by strong mucositis. Chemotherapy had to be interrupted in both children. DIAGNOSIS: Respiratory viral infections, causing pneumonia, occurred in both patients during anticancer treatment. Initially, the real-time polymerase chain reaction test for the swine-origin influenza A was negative in both patients, which delayed the diagnosis. Additionally, bacterial, and fungal complications were also observed. INTERVENTIONS: Both patients received oseltamivir twice a day, a broad-spectrum antibiotic, antifungal drug, and granulocyte colony growth factor. OUTCOMES: The disease progressed quickly, and our patients subsequently died. CONCLUSION: We speculated that early antiviral treatment can help in the better management of patients in the HR group. It is also important to minimize influenza morbidity and mortality by vaccinating family members, using empiric therapy, providing immediate antiviral therapy, and educating parents about hygiene measures.


Assuntos
Influenza Humana/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Antivirais/uso terapêutico , Pré-Escolar , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/tratamento farmacológico , Masculino , Oseltamivir/uso terapêutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Fatores de Risco
16.
PLoS One ; 15(9): e0239258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32961548

RESUMO

BACKGROUND: Viral infections in children and adolescents with malignancy are commonly encountered and have a significant impact on morbidity and mortality. Studies and epidemiological data regarding viral infections in children with cancer in developing countries are lacking. This retrospective cohort study aims to assess the burden of viral infections in children and adolescents with cancer, by assessing prevalence, risk factors, as well as morbidity and mortality of common viruses over a period of 8 years. METHODS AND FINDINGS: Medical records of cancer patients treated at the Children Cancer Center of Lebanon were reviewed and 155 participants under the age of 21 were identified with at least one documented viral infection during the period from July 2009 to November 2017. This subset included 136 participants with active malignancy and 19 participants with a history of cancer who underwent hematopoietic stem cell transplantation [HSCT] and were in remission; the latter group was analyzed separately. Information regarding participant characteristics, hospital course, and complications were obtained. Associations between viral infections and certain factors were assessed. In the cohort, 64% were male, 81% were Lebanese. In participants with active malignancy, 90% received chemotherapy in the 6 months preceding the viral infection episode, 11% received radiotherapy. 51% of participants were neutropenic at the time of viral detection, and 77% were lymphopenic. 17% experienced a bacterial co-infection, and 3 experienced a viral co-infection. Among 162 viral infection episodes, clinically diagnosed skin infections, mainly herpes simplex virus type 1 and varicella-zoster virus, were the most common [44% of cases]. These were followed by laboratory-proven systemic herpes infections: cytomegalovirus [14%] and Epstein-Barr virus [6%]. Respiratory viruses: influenza and respiratory syncytial virus, accounted for 9% and 4%, respectively, whereas rotavirus represented 11% and BK virus represented 3% of cases. Acute lymphocytic leukemia was the most prevalent neoplasia [57%]. Fever was the most common presenting symptom [55%] and febrile neutropenia was the reason for admission in 24% of cases. The mean length of stay was significantly longer in participants with cytomegalovirus infections and significantly lower in rotavirus infection. Admission to the ICU occurred in 9%, complications in 8%, and mortality in 5%. Participants with viral infections post-HSCT were noted to have a significantly longer length of hospital stay compared to non-HSCT participants, with no other significant differences in clinical course and outcome. The study was limited by its retrospective nature and by the late introduction and underuse of multiplex PCR panels, which may have led to underdiagnosis of viral infections. CONCLUSIONS: Viral infections were prevalent in our sample of cancer patients and may have contributed to morbidity and mortality. Newly available viral diagnostics are likely to vastly increase the number and scope of detectable viral infections in this population. Prospective studies using multiplex PCR technology with systematic testing of patients will be more helpful in defining the burden of viral infections. Furthermore, efforts at antimicrobial stewardship would benefit from the identification of viral causes of infection and limit the unnecessary use of antibiotics in the pediatric cancer population.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Influenza Humana/epidemiologia , Neoplasias/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Feminino , Transplante de Células-Tronco Hematopoéticas , Hospitais , Humanos , Lactente , Influenza Humana/complicações , Influenza Humana/diagnóstico , Influenza Humana/virologia , Líbano/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/virologia , Pediatria , Vírus Sincicial Respiratório Humano/genética , Vírus Sincicial Respiratório Humano/isolamento & purificação , Vírus Sincicial Respiratório Humano/patogenicidade , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Estudos Retrospectivos , Infecções por Rotavirus/complicações , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/patologia
17.
BMC Pulm Med ; 20(1): 239, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907585

RESUMO

BACKGROUND: Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown. METHODS: Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. RESULTS: Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681-76.764, p <  0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. CONCLUSIONS: Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.


Assuntos
Hospitalização , Vírus da Influenza A , Influenza Humana/complicações , Aspergilose Pulmonar Invasiva/complicações , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imunocompetência , Influenza Humana/mortalidade , Aspergilose Pulmonar Invasiva/mortalidade , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Fatores de Risco
18.
Chin Med J (Engl) ; 133(20): 2410-2414, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-32842015

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak occurred during the flu season around the world. This study aimed to analyze the impact of influenza A virus (IAV) exposure on COVID-19. METHODS: Seventy COVID-19 patients admitted to the hospital during January and February 2020 in Wuhan, China were included in this retrospective study. Serum tests including respiratory pathogen immunoglobulin M (IgM) and inflammation biomarkers were performed upon admission. Patients were divided into common, severe, and critical types according to disease severity. Symptoms, inflammation indices, disease severity, and fatality rate were compared between anti-IAV IgM-positive and anti-IAV IgM-negative groups. The effects of the empirical use of oseltamivir were also analyzed in both groups. For comparison between groups, t tests and the Mann-Whitney U test were used according to data distribution. The Chi-squared test was used to compare disease severity and fatality between groups. RESULTS: Thirty-two (45.71%) of the 70 patients had positive anti-IAV IgM. Compared with the IAV-negative group, the positive group showed significantly higher proportions of female patients (59.38% vs. 34.21%, χ = 4.43, P = 0.035) and patients with fatigue (59.38% vs. 34.21%, χ = 4.43, P = 0.035). The levels of soluble interleukin 2 receptor (median 791.00 vs. 1075.50 IU/mL, Z = -2.70, P = 0.007) and tumor necrosis factor α (median 10.75 vs. 11.50 pg/mL, Z = -2.18, P = 0.029) were significantly lower in the IAV-positive group. Furthermore, this group tended to have a higher proportion of critical patients (31.25% vs. 15.79%, P = 0.066) and a higher fatality rate (21.88% vs. 7.89%, P = 0.169). Notably, in the IAV-positive group, patients who received oseltamivir had a significantly lower fatality rate (0 vs. 36.84%, P = 0.025) compared with those not receiving oseltamivir. CONCLUSIONS: The study suggests that during the flu season, close attention should be paid to the probability of IAV exposure in COVID-19 patients. Prospective studies with larger sample sizes are needed to clarify whether IAV increases the fatality rate of COVID-19 and to elucidate any benefits of empirical usage of oseltamivir.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Vírus da Influenza A , Influenza Humana/complicações , Pneumonia Viral/mortalidade , Adulto , Idoso , Anticorpos Antivirais/sangue , Feminino , Humanos , Imunoglobulina M/sangue , Vírus da Influenza A/imunologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
J Acquir Immune Defic Syndr ; 85(3): 257-262, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32826562

RESUMO

BACKGROUND: Empirical data on the consequences of the novel coronavirus disease (COVID-19) pandemic on HIV care are lacking. We surveyed people living with HIV (PLWH) in different countries to investigate whether their medical follow-up and psychosocial well-being had been compromised due to COVID-19 and associated restrictions. METHODS: In April 2020, a cross-sectional survey among PLWH was conducted using a web-based multilingual questionnaire. The research tool assessed HIV follow-up, psychosocial well-being, COVID-19 (flu-like) symptoms and prevention measures. Consenting respondents provided answers anonymously. RESULTS: Three hundred seventeen PLWH were included (mean age 43.4 ± 11.7; 71.6% men); 60.3% of participants resided in Belgium and Brazil. One hundred forty (44.2%) reported experiencing a cold with at least one flu-like symptom since January 2020. Of the 18 who reported COVID-19 test results, 4 (22.2%) were positive. Seventy-four (23.3%) respondents screened positive for major depressive disorders, whereas 72 (22.7%) had generalized anxiety disorders. Fifty-six (17.7%) respondents reported difficulties in obtaining antiretroviral medications because of COVID-19-related measures. Adaptations of HIV care during the COVID-19 outbreak included greater quantities of antiretroviral refill in 67 (21.1%), phone consultations in 25 (7.9%), and new refill sites in 12 (3.9%). Factors associated with a reduced risk of experiencing flu-like symptoms included flu vaccination during the past 12 months (P = 0.005) and adaptations of HIV care during the COVID-19 pandemic (P = 0.010). CONCLUSION: COVID-19 and associated restrictive measures seem detrimental to the well-being and follow-up of PLWH. We recommend that health systems devise innovative approaches for antiretroviral provision and psychosocial support to PLWH during such outbreaks.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Infecções por HIV/complicações , Infecções por HIV/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , Ansiedade , Bélgica , Brasil , Estudos Transversais , Depressão , Europa Oriental , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Influenza Humana/complicações , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pandemias , Psicologia , Inquéritos e Questionários , Adulto Jovem
20.
PLoS One ; 15(8): e0236866, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760080

RESUMO

INTRODUCTION: Influenza may precipitate cardiovascular disease, but influenza typically peaks in winter, coinciding with other triggers of myocardial infarction (MI) such as low air temperature, high wind velocity, low atmospheric pressure, and short sunshine duration. OBJECTIVE: We aimed to determine the relationship of week-to-week variation in influenza cases and acute MI, controlling for meteorological factors in a nationwide population. METHODS: Weekly laboratory-confirmed influenza case reports were obtained from the Public Health Agency of Sweden from 2009 to 2016 and merged with the nationwide SWEDEHEART MI registry. Weekly incidence of MI was studied with regard to number of influenza cases stratified into tertiles of 0-16, 17-164, and >164 cases/week. Incidence rate ratios (IRR) were calculated using a count regression model for each category and compared to a non-influenza period as reference, controlling for air temperature, atmospheric pressure, wind velocity, and sunshine duration. RESULTS: A total of 133562 MI events was reported to the registry during the study period. Weeks with influenza cases were associated with higher incidence of MI than those without in unadjusted analysis for overall MI, ST-elevation MI and non ST-elevation MI independently. During the influenza season, weeks with 0-16 reported cases/week were not associated with MI incidence after adjusting for weather parameters, adjusted IRR for MI was 1.03 (95% CI 1.00-1.06, P = 0.09). However, weeks with more cases reported were associated with MI incidence: 17-163 reported cases/week, adjusted IRR = 1.05 (95% CI 1.02-1.08, P = 0.003); and for ≥164 cases/week, the IRR = 1.06 (95% CI 1.02-1.09, P = 0.002). Results were consistent across a large range of subgroups. CONCLUSIONS: In this nationwide observational study, we found an association of incidence of MI with incidence of influenza cases beyond what could be explained by meteorological factors.


Assuntos
Influenza Humana/diagnóstico , Infarto do Miocárdio/diagnóstico , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Influenza Humana/complicações , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Suécia/epidemiologia
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