Etiological structure of acute respiratory viral infections in children hospitalized in 2015-2018

Acute respiratory viral infections (ARVI) play an important role in morbidity formation among children. At the same time, studies about the ARVI etiological structure are not enough. The article presents the results of structure analyses of ARVI in children with severe and moderate degrees of disease hospitalized in the children's clinical hospital of Novosibirsk for the period 2015-2018. This research aimed to analyze the morbidity of acute respiratory viral infections with the estimation of a causal virus in children admitted to the hospital for the period 2015-2018. Material and methods. In this study, 1137 children aged between 0 and 15 years were examined. In order to determine the etiological factor in children with damage of the upper or lower respiratory tract, by using the method of RT-PCR (AmpliSensARVI-screen-FL test systems (InterLabService, Russia), mucus from the nose and throat was examined for the presence of genetic material of viruses that cause ARVI (influenza A and B viruses, parainfluenza viruses of types 1-4, respiratory syncytial virus, metapneumovirus, four types of human coronavirus, rhinovirus, adenovirus, and bocavirus). Results. The research found that the most frequently detected pathogens are respiratory syncytial virus (23.52%), influenza A and B viruses (19.73%) and rhinovirus (19.21%). Observe the dynamics some fluctuations in the detection of mentioned viral agents and increasing of mixed infections were detected. In addition, the importance of respiratory and gastrointestinal tract combined lesions, particularly for infants and preschool - age children has been noted. Conclusion. The distribution of respiratory viruses in children with severe ARVI who required hospitalization was assessed. It was shown the significance of the respiratory syncytial infection virus, influenza virus and rhinovirus in the etiological structure of hospitalized children of different ages that damage not only the respiratory tract, but also to the gastrointestinal tract. This is an important factor in optimizing the diagnosis, treatment and prevention of viral infections in children.Copyright © Infectious Diseases: News, Opinions, Training 2021.

Role of antiviral therapy in respiratory infections in children: Analysis of clinical and laboratory observations.

Objective. To evaluate the efficacy of therapy for acute respiratory viral infections (ARVIs) in children with antiviral medications: inosine pranobex (Groprinosin, Gedeon Richter) and Kagocel (Kagocel, Niarmedic Pharma LLC) in comparison with symptomatic treatment without etiotropic agents based on clinical and laboratory parameters. Patients and methods. The clinical and laboratory observation was conducted in an outpatient setting in the pre-COVID-19 period between 2018 and 2020. Acute respiratory infections were diagnosed using licensed testing systems by multiplex polymerase chain reaction (PCR) with detection of nucleic acid viral genomes: influenza, rhinovirus, respiratory syncytial virus, metapneumovirus, parainfluenza, seasonal coronaviruses, adenoviruses, and bocavirus). A total of 151 children aged 3 to 15 years were examined and monitored in dynamics, with 78.7% of positive and 21.3% of negative results detected by PCR in the nasopharyngeal and oropharyngeal swabs. The patients were randomized into three groups depending on the antiviral medication prescribed: group 1 (53 children) received Groprinosin;group 2 (52 children) received Kagocel;group 3 (control, 46 children) received only symptomatic therapy without antiviral agents. Results. The study demonstrated a significant positive effect in patients in group 1 treated with Groprinosin (n = 53). At the end of therapy for both mono- and mixed infections, there were 95.8% of negative results (according to PCR diagnosis, that is, the absence of viral genome). In children in group 2 (n = 52) treated with Kagocel, the absence of viral nucleic acids (NAs) was observed less frequently (in 77.3% of cases). In children in group 3 (n = 46) who did not receive etiotropic antiviral therapy, there were only 40.3% of negative results after the end of treatment, and viral NAs were detected in 59.7% of patients. In this case, a 5-day course of Groprinosin was prescribed, after which the PCR results became negative in all patients. Therefore, children with recurrent respiratory infections, mixed infections, and herpesvirus infections require longer therapy. Additionally, a high frequency of ARVI complications was noted in group 3 (5 (10.9%) patients, where otitis was observed in 1 case, sinusitis - in 2 cases, bronchitis - in 2 cases), whereas 1 (1.8%) patient taking Groprinosin had otitis, and 1 (1.9%) patient taking Kagocel had pneumonia. Conclusion. This study was the first to investigate antibody titers to respiratory viruses in dynamics at 3, 6 and 12 months after the onset of ARVI. It showed that the development of antibodies to respiratory viruses is very unstable and does not occur in all patients. Antibodies almost disappeared by the third month after ARVI and were no longer detectable by the sixth month. After 12 months, patients suffered a new ARVI and developed the corresponding antibodies. This information will be especially relevant in conditions of the rise in the incidence of ARVIs, as well as the COVID-19 pandemic observed in recent years.Copyright © 2022, Voprosy Prakticheskoi Pediatrii. All rights reserved.

Viral enteritis in cattle: To well known viruses and beyond

Livestock products supply about 13 percent of energy and 28 percent of protein in diets consumed worldwide. Diarrhea is a leading cause of sickness and death of beef and dairy calves in their first month of life and also affecting adult cattle, resulting in large economic losses and a negative impact on animal welfare. Despite the usual multifactorial origin, viruses are generally involved, being among the most important causes of diarrhea. There are several viruses that have been confirmed as etiological agents (i.e., rotavirus and coronavirus), and some viruses that are not yet confirmed as etiological agents. This review summarizes the viruses that have been detected in the enteric tract of cattle and tries to deepen and gather knowledge about them.Copyright © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Prolonged respiratory viral infection associated with presence of coinfections in an urban birth cohort

Background. Prolonged infection by respiratory viruses has been reported, especially in hospitalized or immunocompromised children. However, little is known of factors contributing to prolonged respiratory viral infection, particularly in asymptomatic and less severe infections. We examined characteristics associated with prolonged viral infection in a community-based birth cohort. Methods. The PREVAIL cohort is a CDC-sponsored two-year birth cohort in Cincinnati, Ohio conducted during 4/2017 to 8/2020. Mid-turbinate nasal swabs were collected weekly from children and tested using the Luminex Respiratory Pathogen Panel. The primary outcome was prolonged viral infection, which was defined as a viral nucleic acid detection lasting 4 or more weeks. Proportions of prolonged viral infections were compared using Fisher's exact test with Holms corrections. Adjusted odds ratios (aOR) and 95% confidence intervals were calculated using a mixed effects logistic regression model while controlling for within-subject clustering, viral species, child age, child sex, symptom status, and coinfection. This analysis was limited to subjects who provided at least 70% of weekly samples. Results. Among 101 children, providing 7871 child-weeks of follow-up, we identified 780 viral infections. The median duration of infection across all respiratory viruses was 1 week, except for bocavirus and coronavirus NL63, each with 2 weeks;40% of bocavirus and >10% of adenovirus, coronavirus NL63, RSV A, human metapneumovirus, and parainfluenza 1 infections were associated with prolonged infection (>4 weeks). No prolonged infections were detected for influenza A or B, coronavirus 229E or HKU1, or parainfluenza 2 or 4 infections. Viral coinfection (aOR=3.1, 95% CI 1.9, 5.0) and female sex (aOR 1.8, 95%CI 1.1, 2.9) were significantly associated with prolonged infection, while symptom status and child age were not. Conclusion. In the PREVAIL cohort, detection of respiratory viruses lasting 4 weeks or longer was common for certain respiratory pathogens and was especially prolonged for bocavirus. Biological factors such as the presence of additional viral infections or child sex may affect the likelihood of prolonged infection. (Figure Presented).

Identification of viral agents in children with acute respiratory infection

Introduction: Acute respiratory infections represent a health problem in children, with high morbidity and high mortality rates. Objective(s): To determine the circulation of respiratory viruses in children admitted with a diagnosis of acute respiratory infection, negative to COVID-19. Method(s): Descriptive observational study in 119 children with acute respiratory infection, in the ages from 0 to 6, and with hospital admission in the period from October 2021 to April 2022. Nasopharyngeal exudate samples were taken for virological study (real-time polymerase chain reaction). The variables studied were: age, sex, clinical diagnosis, period of occurrence and isolation of respiratory viruses. Result(s): The female sex predominated with 51% and the age corresponding to the neonatal period with 50 %, followed by infants between 1 and 11 months (40%), and only 10% in the ages from 1 to 6 years. 42 % of the samples with a predominance of CoV229E (78%) were positive;other viruses such as influenza A (6 %), respiratory syncytial (6 %), CoVOC43 (2%) and rhinovirus (2%) were isolated. CoV229E was common in patients with high acute respiratory infection (48.7%), followed by severe acute respiratory infection (20.5%) and bronchiolitis (28.2%). Viral co-infection was detected only in severe acute respiratory infection, specifically by IFA/CoV229E (4%) and CoV229E/bocavirus (2%). Conclusion(s): The importance of molecular biology for viral isolation is highlighted. The Coronavirus CoV229E has relevance in cases of acute high and severe respiratory infection mainly in children under 1 year old. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

Metagenomic Next-Generation Sequencing Reveals the Profile of Viral Infections in Kidney Transplant Recipients During the Covid-19 Pandemic

Purpose: To study the clinical application of metagenomic next-generation sequencing (mNGS) in the detection of viral infections in kidney transplant recipients (KTRs) during the COVID-19 pandemic. Method(s): Using mNGS techniques, 50 human fluid samples of KTRs were detected in Henan Province People's Hospital between May 2020 to May 2021, including 20 bronchoalveolar lavage fluid (BALF) samples, 21 urine samples and 9 blood samples. The detected nucleic acid sequences were compared and analyzed with the existing viral nucleic acid sequences in the database, and the virus infection spectrum of KTRs was drawn. Result(s): The viral nucleic acids of 15 types of viruses were detected in 96.00% (48/50) of the samples, of which 11 types of viruses were in BALF (95.00%, 19/20), and the dominant viruses were torque teno virus (TTV) (65.00%;13/20), cytomegalovirus (CMV) (45.00%;9/20) and human alphaherpesvirus 1 (25.00%;5/20). 12 viruses (95.24%, 20/21) were detected in the urine, and the dominant viruses were TTV (52.38%;11/21), JC polyomavirus (52.38%;11/21), BK polyomavirus (42.86%;9/21), CMV (33.33%;7/21) and human betaherpesvirus 6B (28.57%;6/21). 7 viruses were detected in the blood (100.00%, 9/9), and the dominant virus was TTV (100.00%;9/9). Four rare viruses were detected in BALF and urine, including WU polyomavirus, primate bocaparvovirus 1, simian virus 12, and volepox virus. Further analysis showed that TTV infection with high reads indicated a higher risk of acute rejection (P<0.05). Conclusion(s): mNGS detection reveals the rich virus spectrum of infected persons after kidney transplantation, and improves the detection rate of rare viruses. TTV may be a new biomarker for predicting rejection. (Figure Presented).

Pulmonary palytoxin poisoning on CT imaging

Background: Palytoxin poisoning is an uncommon exposure in the US, and is most frequently encountered amongst hobbiests and professionals in the aquarium industry. The toxin is produced by the microalgae Ostreopsis as well as the coral Palythoa toxica. Discovered in Hawaii, the name limu-make-o-Hana translates to "seaweed of death from Hana." Palytoxin interrupts Na+/ K+ ATPase pump, resulting in widespread cellular dysfunction. Persons are at highest risk when cleaning a fish tank housing the coral that produces palytoxin, resulting in cutaneous or inhalational exposure. We present a case of palytoxin inhalational exposure with computed tomography (CT) imaging. Case report: A 41-year-old male presented to the emergency department (ED) with dyspnea, cough, and wheezing after cleaning his saltwater fish tank. He reported that he maintains Zoanthid corals in his home saltwater fish tank and typically wears personal protective equipment when cleaning the tank. He had taken off his mask directly after using hot water to clean the tank, and quickly developed shortness of breath. He contacted Poison Control and was instructed to take loratadine with initial improvement in his symptoms. He then developed decreased appetite, nausea, and chills. The following day, in addition to these symptoms, he developed a fever of 102.5 degreeF and an oxygen saturation of 88% measured with an at-home pulse oximeter. He then proceeded to the ED where he was found to be hypoxic to 91% on room air, tachycardic to 120 bpm, hypotensive to 93/ 70mmHg, febrile to 100.9 degreeF and tachypneic at a respiratory rate of 30. Physical exam revealed clear lung sounds. Application of supplemental oxygen at 2 L resulted in improvement in his oxygen saturation and his hypotension and tachycardia responded to intravenous fluids. Significant laboratory results included WBC count of 20.4 with bands of 14%, elevated lactate of 2.4mmol/L, elevated D-dimer of 0.48 mug/mL and a negative COVID PCR test. CTA thorax revealed patchy ground-glass opacities in the bilateral upper and lower lobes with mosaicism. The patient received doxycycline in addition to broad spectrum antibiotics due to concern for inhalational marine toxicity. He was also started on 60mg prednisone, inhaled steroids, and bronchodilators for symptomatic treatment, with improvement in his symptoms. During his hospitalization, a respiratory viral panel was negative for common viruses associated with atypical pneumonia including influenza, coronavirus, metapneumovirus, rhinovirus, enterovirus, adenovirus, parainfluenza, bocavirus, Chlamydophila pneumoniae, and Mycoplasma pneumonia. His dyspnea gradually improved and he was weaned off supplemental oxygen prior to discharge home on hospital day 2. Discussion(s): It is unclear what changes are expected on thoracic imaging in patients with inhalational palytoxin exposure. Chest radiographs in two previous cases displayed scattered infiltrates, and a chest CT in another case showed pleural based consolidations. The ground-glass mosaicism suggests that a more diffuse reactive airway process after an inhalational palytoxin insult. Conclusion(s): Patients with inhalational palytoxin exposure may be found to have reactive airway symptoms along with ground glass opacities with mosaicism on CT imaging.

Aetiological diagnosis of acute respiratory illness in patients under investigation for the novel corona virus (SARS-CoV-2) before major Covid-19 outbreak in India

Background:The first case of COVID-19 was reported in India on 30th January 2020 with origin from China (PIB 2020, ‘https:// pib.gov.in/pressreleaseiframepage.aspx?prid=1601095’). As on 6th May 2020 the total cases reported in India are 35,043, with 8,889 recoveries and 1,147 deaths (https://www.mohfw.gov.in/ accessed on 6th may at 12:54 PM). However, the rate of infection is lower as compared to other countries. Since the Covid-19 pandemic started spreading in world outside China including India and large scale testing for Covid-19 became available, all the focus suddenly shifted to Covid-19. Other respiratory viruses, which were in existence for many years and testing and management of these infection was always standard of care, started getting neglected. Hence, we analysed the retrospective laboratory results from cases of acute respiratory infection, tested in the month of February 2020, when Covid-19 cases in India were close to negligible. This is to focus on need of testing for other respiratory viruses along with Covid-19 so that these infections can be managed as per standard protocol and do not get neglected in the wake of pandemic. Methods:The Virus research and diagnostic laboratory at Department of Microbiology, King George’s Medical University (VRDL) start- ed testing for Covid-19 on 3rd February 2020. This laboratory routinely tests all patients presenting as Severe Acute Respiratory Ill- ness (SARI) for 12 respiratory viruses including Influenza (Inf) A (both H1N1 and H3N2) and B, Adenovirus (ADV), Respiratory syntitial virus (RSV), Parainfluenza (Parainf) viruses 1, 2, 3 and 4, Measles virus (MEV), Bocavirus, Human metapneumo virus (HMPV) and Rhi- noviruses (Rhino). All patients presenting as Influenza like illness (ILI) are routinely tested for Influenza A and B viruses. If they test negative, other viruses are tested depending on clinical suspicion. The testing is routinely done as per methods described earlier (Singh A.K., Jain A., Jain B., Singh K.P., Dangi T., Mohan M. Viral aetiology of acute lower respiratory tract illness in hospitalised paedi- atric patients of a tertiary hospital: one year prospective study Indian J Med Microbial. 2014;32:13–18). Results:During February 2020, we tested 316 cases of SARI/ ILI for covid-19. None of them tested positive for Covid-19. Samples from these cases were also tested for other respiratory viruses as mentioned above. Total 10 (3.2%, 8 H1N1 (2.5%) and 2 H3N2 (0.6%)) samples tested positive for Influenza A, 2 each tested positive for Influenza B, HMPV and Adenoviruses. One sample each tested posi- tive for RSV and Rhinoviruses. Total 5 samples tested positive for parainfluenza viruses;3 for parainfluenza 1, and 1 each for parain- fluenza 1 and 4 Conclusions :( table). The positivity for covid-19 in India in pandemic time remains less than 4% (https://www.mohfw.gov.in/ ac- cessed on 06 May 2020, 08:00 IST), while the positivity for rest of the respiratory viruses as shown in present analysis is 7.3%. It is essential to see that infection with other respiratory viruses does not get neglected and add to the Covid-19 misery.

A case of acute encephalopathy with biphasic seizures and delayed diffusion changes

Acute encephalopathy with biphasic seizures and delayed diffusion changes (AESD) is an extremely rare syndrome outside Asia. AESD is diagnosed based on clinic-radiological correlation. Influenza or human herpesvirus 6 infection have been most commonly isolated in previously healthy children with AESD and there is possible correlation with genetic abnormalities such as mutations in the SCN1A gene. We report a 2 year old previously fit and well white female who presented febrile status epilepticus at day 3 of an upper respiratory tract infection with subsequent prolonged left facial palsy and left hemiparesis. Brain MRI on day 4 showed swelling and diffusion restriction of the right hippocampus, without any other focal abnormality or signs of ischaemia. On day 6 she presented clusters of focal left sided seizures, non-responding to treatment Levetiracetam and sodium valproate add on. Repeated brain MRI on 7 showed prolonged and diffuse diffusion restriction over the whole right hemisphere, which along with the characteristic clinical presentation led to the diagnosis of AESD. She received high dose IV steroids with taper over 6 weeks starting on day 9. The seizures stopped on day 10 but motor function recovery was slow. CSF analysis showed no signs of infection. Nasopharyngeal swab was positive for Bocavirus and she had positive antibodies for SARS-COV-2 with negative PCR. Genetic investigations were requested and are pending. This case illustrates the importance of repeated brain imaging in abrupt onset refractory seizures with abnormal neurological examination which can lead to early diagnosis and treatment. More studies are needed to investigate the correlation between SARs-COV-2 or Bocavirus and AESD.

CRIANÇAS COM SÍNDROME RESPIRATÓRIA AGUDA GRAVE (SRAG) CONFIRMADA EM HOSPITAL DE REFERÊNCIA PEDIÁTRICA EM BELO HORIZONTE, MINAS GERAIS

Introdução: Descrever o perfil epidemiológico de crianças com infecção confirmada por SRAG internadas no Hospital Infantil João Paulo II (HIJPII), referência em doenças infectocontagiosas, entre março de 2020 e agosto de 2021. Método: Trata-se de um estudo realizado pelo Núcleo de Vigilância Epidemiológica Hospitalar (NUVEH) do HIJPII, utilizando os dados das fichas de notificação de SRAG, Este estudo foi aprovado pelo Comité de Ética em Pesquisa da FHEMIG sob parecer: 4.312.966. Resultados: Entre março de 2020 e agosto de 2021, 2702 crianças internaram no HIJPII e foram notificados com SRAG. Foram realizados 2269 testes RT-PCR para SARS-CoV-2, 1026 pacientes realizaram teste rápido de antígeno e/ou fizeram o painel viral na Fundação Ezequiel Dias. A etiologia viral foi identificada em 692 crianças: 278 (40,2%) positivos para vírus sincicial respiratório (VSR), 174 (25,1%) positivos para rinovírus, 164 (23,7%) positivos para SARS-CoV2, 34 (4,9%) positivos para influenza A e/ou B, e 5,9% foram positivos para outros vírus (25 bocavirus, 3 parainfluenza, 13 adenovírus e 1 coronavírus sazonal). O diagnóstico de VSR foi realizado por RT-PCR em 72% e teste rápido de antígeno em 28%. SARS-CoV-2 foi detectado por RT-PCR em 81% e por teste rápido de antígeno em 19%. A idade variou entre 15 dias de vida e 18 anos, mas 72,9% eram menores de 6 anos, 55,5% do sexo masculino, 82% moravam em Belo Horizonte ou na região metropolitana. Entre as manifestações clínicas mais frequentes foram febre, tosse, diarreia, esforço respiratório, cianose e saturação menor que 95%. Nos casos mais graves as crianças tinham comorbidades, as mais frequentes: displasia broncopulmonar, doença neurológica crônica não progressiva, obesidade, anemia falciforme e cardiopatia. A letalidade por SRAG no HIJPII no período foi de 20,5% (4 crianças com SARS-CoV-2 e uma criança com VRS);entretanto apenas 29,4% dos óbitos por SRAG tiveram a etiologia viral identificada por não terem coletado painel viral. Conclusão: Os resultados encontrados reforçam a necessidade da realização do painel viral, para melhorar os dados da Vigilância Epidemiológica. Sua solicitação foi reduzida na pandemia, devido ao alto número de internações e necessidade de leitos, optou-se por realizar testes rápidos. Entretanto, como no HIJPII estão disponíveis testes rápidos apenas para VRS, SARS-CoV-2 e influenza, muitas crianças com SRAG ficaram sem identificação viral.