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1.
Journal of Virus Eradication ; : 100305, 2022.
Article in English | ScienceDirect | ID: covidwho-2150229

ABSTRACT

Rhinoviruses (RVs) and coronaviruses (CoVs) upregulate host cell metabolic pathways such as glycolysis to meet their bioenergetic demands for rapid multiplication. Using the glycolysis inhibitor 2-deoxy-D-glucose (2-DG), we assessed the dose-dependent inhibition of viral replication of minor- and major-receptor group RVs in epithelial cells. 2-DG disrupted RV infection cycle by inhibiting template negative-strand as well as genomic positive-strand RNA synthesis, resulting in less progeny virus and RV-mediated cell death. Assessment of 2-DG´s intracellular kinetics revealed that after a short-exposure to 2-DG, the active intermediate, 2-DG6P, is stored intracellularly for several hours. Finally, we confirmed the antiviral effect of 2-DG on pandemic SARS-CoV-2 and showed for the first time that 2-DG also reduces replication of endemic human coronaviruses (HCoVs). These results provide further evidence that 2-DG could be utilized as a broad-spectrum antiviral.

2.
J Med Virol ; 94(8): 3829-3839, 2022 08.
Article in English | MEDLINE | ID: covidwho-2127821

ABSTRACT

Respiratory infections are often caused by enteroviruses (EVs). The aim of this study was to identify whether certain types of EV were more likely to cause severe illness in 2016, when an increasing spread of upper respiratory infections was observed in Gothenburg, Sweden. The EV strain in 137 of 1341 nasopharyngeal samples reactive for EV by polymerase chain reaction could be typed by sequencing the viral 5'-untranslated region and VP1 regions. Phylogenetic trees were constructed. Patient records were reviewed. Hospital care was needed for 46 of 74 patients with available medical records. The majority of the patients (83) were infected with the rhinovirus (RV). The remaining 54 were infected with EV A, B, C, and D strains of 13 different types, with EV-D68 and CV-A10 being the most common (17 vs. 14). Significantly more patients with EV-D68 presented with dyspnea, both when compared with other EV types (p = 0.003) and compared to all other EV and RV infections (p = 0.04). Phylogenetic analysis of the sequences revealed the spread of both Asian and European CV-A10 strains and 12 different RV C types. This study showed an abundance of different EV types spreading during a year with increased upper respiratory increased infections. EV-D68 infections were associated with more severe disease manifestation. Other EV and RV types were more evenly distributed between hospitalized and nonhospitalized patients. The EV type CV-A10 was also found in infected patients, which warrants further studies and surveillance, as this pathogen could cause more severe disease and outbreaks of hand, foot, and mouth disease.


Subject(s)
Enterovirus D, Human , Enterovirus Infections , Enterovirus , Respiratory Tract Infections , Disease Outbreaks , Enterovirus/genetics , Humans , Infant , Phylogeny , Rhinovirus/genetics
3.
Open Forum Infect Dis ; 9(11): ofac531, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2115835

ABSTRACT

Background: We conducted this study to assess the prevalence of viral coinfection in a well characterized cohort of hospitalized coronavirus disease 2019 (COVID-19) patients and to investigate the impact of coinfection on disease severity. Methods: Multiplex real-time polymerase chain reaction testing for endemic respiratory viruses was performed on upper respiratory tract samples from 1002 patients with COVID-19, aged <1 year to 102 years old, recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK study. Comprehensive demographic, clinical, and outcome data were collected prospectively up to 28 days post discharge. Results: A coinfecting virus was detected in 20 (2.0%) participants. Multivariable analysis revealed no significant risk factors for coinfection, although this may be due to rarity of coinfection. Likewise, ordinal logistic regression analysis did not demonstrate a significant association between coinfection and increased disease severity. Conclusions: Viral coinfection was rare among hospitalized COVID-19 patients in the United Kingdom during the first 18 months of the pandemic. With unbiased prospective sampling, we found no evidence of an association between viral coinfection and disease severity. Public health interventions disrupted normal seasonal transmission of respiratory viruses; relaxation of these measures mean it will be important to monitor the prevalence and impact of respiratory viral coinfections going forward.

4.
Clin Exp Otorhinolaryngol ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2111305

ABSTRACT

Chronic rhinosinusitis (CRS) is a complex inflammatory disorder that affects between 2 and 16% of adults in the United States with estimated healthcare costs between 4 to 12 million USD. Viruses are a frequent cause of upper respiratory infections and a trigger for CRS exacerbations. There are several cross-sectional studies that have identified types of viruses associated with CRS. Rhinovirus, parainfluenza virus, influenza virus, and respiratory syncytial virus were the main associated viruses found in nasal lavage samples of patients with CRS. Other viruses such as adenovirus or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have weak associations with CRS and were excluded from the review. Rhinovirus and its subtypes utilize glycoproteins like intercellular adhesion molecule 1 (ICAM-1), low density lipoprotein receptor (LDLR) family members, and cadherin-related family member 3 (CDHR3) to invade host cells. Influenza and parainfluenza virus invade through the binding of hemagglutinin (HA) to sialic acid-containing molecules while respiratory syncytial virus has a RSV specific glycoprotein that binds to the cellular receptor human nucleolin (NCL). Viral infection that causes CRS is frequently associated with type 1 and type 2 immune responses. Dysregulated immune response to viral infections can result in the activation of airway remodeling, epithelial-mesenchymal transitions, and epithelial barrier breakdown that are central to the pathogenesis of CRS. Risk factors for viral infections in CRS. Dysfunctional epithelial barrier function and age are strong risk factors for CRS infections. Comorbid respiratory diseases like asthma or allergic rhinitis are highly associated with CRS risk and CRS exacerbations. Children are also more likely to have upper respiratory tract infections than adults and viruses associated with CRS are more prevalent in infants and children. Studying and understanding the role of viruses in CRS is an important step in identifying disease pathogenesis and targeting these pathways early to slow disease progression.

5.
Cureus ; 14(9): e29380, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2090851

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) is a serious sequela of acute SARS-CoV-2 infection. It is unclear whether the co-occurrence of other viral respiratory illnesses, such as the human rhino-enterovirus (HRV/ENT), prolongs hospitalization or affects the clinical phenotype of patients with MIS-C. We report the hospital course of a three-year-old with MIS-C and HRV/ENT infection, who tested positive for HRV/ENT infection a few days prior to re-presenting for six days of fever, one day of emesis, bilateral conjunctivitis, and shortness of breath, all consistent with MIS-C. Due to worsening hypotension, he was admitted to a pediatric intensive care unit (ICU) at a tertiary center, where he received vasoactive support, intravenous immunoglobulin, and high-dose intravenous steroids. Because of his worsening respiratory status, he was also started on anakinra with resultant gradual improvement. He was hospitalized for a total of 15 days. Concurrence of other viral infections may prolong hospitalization for patients with MIS-C.

6.
Viruses ; 14(11)2022 Oct 25.
Article in English | MEDLINE | ID: covidwho-2090353

ABSTRACT

Since their discovery in the 1950s, rhinoviruses (RVs) have been recognized as a major causative agent of the "common cold" and cold-like illnesses, accounting for more than 50% of upper respiratory tract infections. However, more than that, respiratory viral infections are responsible for approximately 50% of asthma exacerbations in adults and 80% in children. In addition to causing exacerbations of asthma, COPD and other chronic lung diseases, RVs have also been implicated in the pathogenesis of lower respiratory tract infections including bronchiolitis and community acquired pneumonia. Finally, early life respiratory viral infections with RV have been associated with asthma development in children. Due to the vast genetic diversity of RVs (approximately 160 known serotypes), recurrent infection is common. RV infections are generally acquired in the community with transmission occurring via inhalation of aerosols, respiratory droplets or fomites. Following the outbreak of coronavirus disease 2019 (COVID-19), exposure to RV and other respiratory viruses was significantly reduced due to social-distancing, restrictions on social gatherings, and increased hygiene protocols. In the present review, we summarize the impact of COVID-19 preventative measures on the incidence of RV infection and its sequelae.


Subject(s)
Asthma , COVID-19 , Communicable Diseases , Picornaviridae Infections , Respiratory Tract Infections , Child , Adult , Humans , Rhinovirus/genetics , COVID-19/prevention & control , Physical Distancing , Asthma/complications , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/prevention & control , Respiratory Tract Infections/complications , Picornaviridae Infections/epidemiology , Picornaviridae Infections/prevention & control , Picornaviridae Infections/complications
7.
Trop Med Infect Dis ; 7(11)2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2090351

ABSTRACT

The COVID-19 pandemic circumstances have varied the pathogens related to acute respiratory infections (ARI), and most specialists have ignored them due to SARS-CoV-2's similar symptomatology. We identify respiratory pathogens with multiplex PCR in samples with presumptive SARS-CoV-2 but negative RT-qPCR results. We performed a retrospective transversal study employing clinical data and nasopharyngeal swab samples from patients with suspected clinical SARS-CoV-2 infection and a negative PCR result in a private laboratory in Lima, Peru. The samples were analyzed using the FilmArray™ respiratory panel. Of 342 samples, we detected at least one pathogen in 50% of the samples. The main ones were rhinovirus (54.38%), influenza A(H3N2) (22.80%), and respiratory syncytial virus (RSV) (14.04%). The clinical characteristics were sore throat (70.18%), cough (58.48%), nasal congestion (56.43%), and fever (40.06%). Only 41.46% and 48.78% of patients with influenza met the definition of influenza-like illness (ILI) by the World Health Organization (WHO) (characterized by cough and fever) and the Centers for Disease Control and Prevention (CDC) (characterized by fever and cough and sore throat), respectively. A higher prevalence of influenza was associated with ILI by WHO (aPR: 2.331) and ILI by CDC (aPR: 1.892), which was not observed with other respiratory viruses. The clinical characteristic associated with the increased prevalence of rhinovirus was nasal congestion (aPR: 1.84). For patients with ARI and negative PCR results, the leading respiratory pathogens detected were rhinovirus, influenza, and RSV. Less than half of patients with influenza presented ILI, although its presence was specific to the disease.

8.
American Journal of Transplantation ; 22(Supplement 3):647-648, 2022.
Article in English | EMBASE | ID: covidwho-2063486

ABSTRACT

Purpose: Respiratory viral infection, including COVID-19, causes significant morbidity and mortality in solid organ transplant recipients (SOTR), however, the data of parainfluenza virus (PIV) type 3 infection in this population is still limited. The aim of this study was to reveal the clinical picture of PIV type 3 infection in SOTR. Method(s): This was a retrospective cohort study, conducted between 01/01/2017 and 08/31/2021. We included adult SOTR with an active graft whose respiratory specimen, either nasopharyngeal swab or bronchoalveolar lavage, was positive for PIV type 3 via Filmarray 2.0 and Torch, BioMerieux. Lower respiratory tract infection was defined as any chest radiological abnormality. Result(s): We identified 25 patients including 14 kidney, 4 lung, 3 heart, 1 liver, and 3 combined transplant recipients (Table 1). Hospital and intensive care unit admission rate was 88% (22/25) and 16% (4/25), respectively. Lower respiratory tract infection was seen in 44% (11/25). No specific treatments for PIV type 3 were given to this cohort. Co-, secondary infection was observed in 4 (16%) SOTR with 2 Enterovirus/ Rhinovirus, 1 Fusobacterium bacteremia, and 1 Pseudomonas aeruginosa pneumonia. Only 2 (8%) died within three months after diagnosis. Conclusion(s): PIV type 3 in SOTR showed favorable outcome and no episodes of rejection occurring during follow up. Further studies should be needed to identify the risk factors for mortality.

9.
Clinical Toxicology ; 60(Supplement 2):121, 2022.
Article in English | EMBASE | ID: covidwho-2062721

ABSTRACT

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.

10.
Chest ; 162(4):A2571-A2572, 2022.
Article in English | EMBASE | ID: covidwho-2060966

ABSTRACT

SESSION TITLE: Pulmonary Issues in Transplantation Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: We describe two unvaccinated lung transplant recipients (LTRs) with mild COVID-19 and prolonged SARS-CoV-2 colonization who presented with recrudescence of symptoms due to superinfection. CASE PRESENTATION: Case 1: A 57-year-old LTR (August 2018) presented to the emergency room (ER) in July 2020 with headache, positive SARS-CoV-2 nasopharyngeal swab-PCR result, and elevated D-Dimer. He recovered at home and tested negative for SARS-CoV-2 on day 28. He presented to the ER again in October 2020 with chest pain. At this time, evaluation revealed a positive SARS-CoV-2 nasopharyngeal swab-PCR result, positive SARS-CoV-2 IgG (index 3.41), leukocytosis, and elevated inflammatory markers. Of note, nasopharyngeal swab was also positive for rhinovirus. Imaging showed new mild bibasilar ground-glass opacities. Patient was treated with remdesevir, convalescent plasma, and pulse corticosteroid. His SARS-CoV-2 PCR test was negative on day 3 of the remdesevir regimen;he remains clear of SARS-CoV-2 and rhinovirus to date, with complete clinical and radiologic recovery (Figure 1, Case 1). His immunosuppression was unchanged. Case 2: A 75-year-old LTR (July 2016) with pancytopenia presented for a sick visit in May 2020 with cough and fever. His SARS-CoV-2 nasal wash-PCR test was positive;imaging was unremarkable. He was sent home on pulse corticosteroid and levofloxacin. A week later in June 2020, he presented to the ER with worsening cough. At this time, evaluation revealed positive SARS-CoV-2 IgG (index 7.58), leucopenia, thrombocytopenia, elevated inflammatory markers, and new radiographic bibasilar ground-glass opacities (Figure 1, Case 2). His condition improved with intravenous antibiotics and corticosteroids. He consistently tested positive for SARS-CoV-2 in nasal wash samples for 3 months, with the first negative test in September 2020. He was hospitalized in January 2021 for neutropenic fever, P. Aeruginosa (PsA) infection in bronchoalveolar lavage (BAL), and anti-PsA antibodies in the serum. At this time, he also had SARS-CoV-2 colonization in BAL despite negative PCR results of nasal wash samples. His condition improved with 14 days of antibiotics. He was stable at his last follow-up. DISCUSSION: Both patients had an initial episode of mild COVID-19 pneumonitis, appropriate seroconversion, and prolonged viral colonization in the respiratory tract. Immunosuppression may have predisposed to rhinovirus and PsA superinfection in case 1 and 2, respectively. CONCLUSIONS: A high index of suspicion for superimposed infections in LTRs recovering from COVID-19 is warranted. Reference #1: 1. Hogan JI, Kotton CN. A Call for Caution in the Immunocompromised: Coronavirus Disease 2019 Associated With Mortality in a Vaccinated Lung Transplant Recipient. Open Forum Infect Dis. 2021 Nov 10;8(12):ofab557. DISCLOSURES: No relevant relationships by Hesham Abdelrazek No relevant relationships by Ashwini Arjuna No relevant relationships by Bhuvin Buddhdev No relevant relationships by Deepika Razia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia No relevant relationships by Rajat Walia, value=Honoraria Removed 04/04/2022 by Rajat Walia

11.
Chest ; 162(4):A498, 2022.
Article in English | EMBASE | ID: covidwho-2060613

ABSTRACT

SESSION TITLE: Critical Care in Chest Infections Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The "common cold” is a syndrome defined by upper respiratory symptoms in addition to: rhinorrhea, fever, chills, headache, and/or malaise. Classically "colds” are thought of as a mild, self-limiting disease;however, they can cause severe respiratory symptoms in immunocompetent individuals. We present a case of severe acute respiratory distress syndrome (ARDS) caused by the Human Rhinovirus in an immunocompetent host. CASE PRESENTATION: 61-year-old gentleman with a past medical history significant for hypertension presented to an outside hospital for worsening shortness of breath, fatigue, and cough with production x 3 weeks. Social history is notable that he had a 12-pack-year history and quit smoking tobacco approximately 10 years ago. On arrival, the patient was noted to be hypoxic with percent saturation of 88% on 2 L nasal cannula. He rapidly deteriorated and required intubation 5 days after admission. The patient subsequently transferred to a tertiary care intensive care unit for further workup and management. Upon arrival at the tertiary care center, he was found to have a PaO2/FiO2 ratio of 71 and ARDS protocol was initiated. Despite pronation, paralyzation, dexamethasone, and nitric oxide, the patient continued to deteriorate. Three COVID-19 PCR's and COVID-19 antibody resulted negative. Extensive work-up including fungal, autoimmune, viral, and bacterial were negative with the exception of a positive rhinovirus PCR. MRI brain was completed due to patient's unequal pupils which demonstrated numerous recent infarcts of the bilateral cerebral and cerebellar hemispheres with mass-effect with mild leftward shift. The family ultimately decided to pursue comfort measures and the patient died. DISCUSSION: Human Rhinovirus is responsible for ? to ½ of common colds in adults making it the most common cause of "colds.” Due to its more than 100 serotypes, an average adult has approximately 2-3 Rhinovirus infections per year. Rhinovirus infections are classically thought to be self-resolving and mild, particularly in the immunocompetent. However, several recent studies have shown coinfection of the rhinovirus in patients with community acquired pneumonia;although these studies have been unable to tease out how clinically significant the rhinovirus infection was in these patients. The patient case above is an example that the Rhinovirus may be a more important culprit in community-acquired pneumonia than previously suspected. In addition to its possible respiratory conditions, studies have demonstrated an increase in risk of stroke. Currently, there are no FDA-approved antivirals for the Human Rhinovirus, treatment largely aimed to reduce symptomatology. CONCLUSIONS: The medical community, in large, thinks of the Rhinovirus as a relatively benign disease process. Though this may be the case in most patients, even immunocompetent individuals can suffer from serious complications of the virus. Reference #1: Chu HY;Englund JA;Strelitz B;Lacombe K;Jones C;Follmer K;Martin EK;Bradford M;Qin X;Kuypers J;Klein EJ;"Rhinovirus Disease in Children Seeking Care in a Tertiary Pediatric Emergency Department.” Journal of the Pediatric Infectious Diseases Society, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/26908489/. Reference #2: JO;, Proud D;Naclerio RM;Gwaltney JM;Hendley. "Kinins Are Generated in Nasal Secretions during Natural Rhinovirus Colds.” The Journal of Infectious Diseases, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/2295843/. Reference #3: Subramanian, A., et al. "Stroke Following Positive Biomarker for Viral Respiratory Illnesses.” B47. CRITICAL CARE: NON-PULMONARY CRITICAL CARE, 2020, https://doi.org/10.1164/ajrccm-conference.2020.201.1_meetings.a3566. DISCLOSURES: No relevant relationships by Philip Forys No relevant relationships by Brandon Pearce

12.
Chest ; 162(4):A488, 2022.
Article in English | EMBASE | ID: covidwho-2060607

ABSTRACT

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Community Acquired Respiratory Viruses (CARVs) are associated with poor outcome in Solid Organ Transplant (SOT) recipients. We reviewed some of these outcomes such as respiratory support, length of stay (LOS), ICU admission, steroid use & 30-day all-cause mortality. METHODS: Multihospital, single center, retrospective review of electronic health records from 01/01/2014-12/31/2019. RESULTS: 23 SOT recipients (M=20, F=3) who tested positive for CARVs were identified. SOT distribution was heart=2, kidney=4, liver=3, lung=11, heart-lung=1, lung-kidney=1 & heart-kidney=1. Mean age at admission was 60 years, average LOS was 8 days with 2 pts needing >2 weeks. 6 pts required intensive care unit;8 pts required supplemental oxygen support. 16 pts had infiltrates on chest imaging. 15 pts had a 90-day readmission with respiratory complaints. 8 pts had bronchoscopy & 20 had positive nasal swab. 3 pts had a negative nasal swab but positive Bronchoalveolar lavage (BAL) for CARV while 2 pts had negative BAL but positive nasal swab. CARV distribution was Rhinovirus 48%, Parainfluenza 29%, Metapneumovirus 12%, Respiratory syncytial virus 0.03%, Adenovirus 0.03% & Non-novel Coronavirus 0.06%. 5 pts had bacterial coinfection (Pseudomonas aeruginosa, Corynebacterium striatum & Stenotrophomonas maltophilia). All pts were immunosuppressed, intravenous immunoglobulins (IVIG) were used in 3 pts, antivirals in 7 pts (ribavirin in 6 & oseltamivir in 1) & steroids in 10 pts. 12 pts had transplant organ biopsy with 5 showing acute cellular rejection. 11 pts had underlying Coronary artery disease and 17 pts had hematologic disorders (Post-transplant lymphoproliferative disorder, leukemia, Myelodysplastic syndrome, & multiple myeloma). 35% pts died within 1 year (2 during same admit). Cause of death was refractory septic shock (1), respiratory failure (3), cardiac arrest (3) & chronic lung allograft dysfunction (CLAD) (1). CONCLUSIONS: In this cohort, we assessed the SOT recipients positive for CARVs who required admission & evaluated the impact on their clinical course. This analysis noted a significant rate of acute & chronic rejections, bronchiolitis obliterans and CLAD in these patients. Newer tests like multiplex NAT & (semi) quantitative NAT (QNAT) can diagnose CARVs in addition to Human Influenza Virus. Patients can present with wheezing, croup, bronchiolitis, pneumonitis & pneumonia. Impact of CARVs seems to vary by the type of organ transplant, level of neutropenia/lymphopenia, upper versus lower respiratory infection and intrinsic pathogenicity of virus. Various preventive & therapeutic measures were employed in an attempt to improve outcomes in these patients. CLINICAL IMPLICATIONS: Transplant receipients are at a high risk of infections especially CARVs which may increase morbidity and mortality. This analysis emphasizes the value of timely diagnosis and treatment in this specific patient population who are immunocompromised. DISCLOSURES: No relevant relationships by Supriya Singh

13.
Chest ; 162(4):A423-A424, 2022.
Article in English | EMBASE | ID: covidwho-2060593

ABSTRACT

SESSION TITLE: Challenging Cases of Hemophagocytic Lymphohistiocytosis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive immune activation in response to a variety of insults including malignant, autoimmune and infectious processes. The most common infectious trigger is a viral infection, but other pathogens have also been implicated including Mycobacterium tuberculosis (MTB) CASE PRESENTATION: 62-year-old male from Bangladesh presented due to lethargy, weakness, and anorexia for several weeks. He also reported fevers, diarrhea, and unintentional weight loss. On examination, he appeared acutely ill with diffuse bibasilar crackles on lung exam. Labs showed platelets of 132, ESR 45 mm/hr, CRP 9.6mg/dL, ferritin 1,765ng/mL and transaminitis. A viral panel was positive for Rhinovirus. Computed tomography (CT) of the chest showed diffuse bilateral ground-glass opacities and he was started on antibiotics for pneumonia. On day 3, his respiratory status worsened and he was emergently intubated. He underwent bronchoscopy and bronchoalveolar lavage (BAL) and started on high-dose steroids for possible hypersensitivity pneumonitis. On day 5, he was extubated to nasal cannula, however, his condition worsened despite treatment. Extensive infectious workup, including HIV, Covid and P jirovecii PCR, sputum, and blood cultures, and preliminary AFB smear were negative. Subsequent labs noted rising ferritin levels (4,164 ng/mL), high triglycerides, pancytopenia and transaminitis. Calculated H score was 211 which gave a 93-96% probability of HLH. Initiation of Etoposide was discussed but family deferred. He was later transferred to another facility. On follow-up, IL-2 receptor antibodies were elevated, bone marrow biopsy showed hemophagocytosis and necrotizing granulomas. He was intubated for worsening hypoxemia. Repeat bronchoscopy and BAL analysis showed many acid-fast bacilli. Anti TB treatment (ATT) was deferred due to his critical state. He further declined and eventually expired. DISCUSSION: The exact mechanism for which MTB triggers HLH is unclear, however, it is thought that MTB serves as an obligate intracellular pathogen after phagocytosis by phagocytic cells to induce TH1-mediated cytotoxicity, activating macrophages and NK cells, further releasing a large quantity of cytokines and chemokines. The lack of specific clinical signs, low sensitivity for acid-fast staining, and time-consuming culture make the diagnosis of TB-HLH difficult. However, the use of NAATs has improved the yield of sputum testing. Exceedingly high ferritin levels should serve as a red flag in cases of undetermined diagnosis. Moreso, Cytopenias, elevated LFTs, and coagulation dysfunction are other clues that a diagnosis of HLH should be on the differential. It is believed that early and effective ATT is the key to preventing HLH in TB patients. CONCLUSIONS: It is paramount to both recognize the features of TB as well as HLH as early diagnosis and treatment favor better outcomes. Reference #1: Padhi S, Ravichandran K, Sahoo J, Varghese RG, Basheer A. Hemophagocytic Lymphohistiocytosis: An Unusual Complication in Disseminated Mycobacterium Tuberculosis. Lung India (2015) 32(6):593–601. doi: 10.4103/0970-2113.168100 Reference #2: Dalugama, C., Gawarammana, I.B. Fever with pancytopenia: unusual presentation of extrapulmonary tuberculosis: a case report. J Med Case Reports 12, 58 (2018). https://doi.org/10.1186/s13256-018-1596-0 Reference #3: O M P Jolobe, Timely recognition of hematophagocytosis attributable to coexistence of lymphoma and tuberculosis, QJM: An International Journal of Medicine, Volume 112, Issue 4, April 2019, Page 315, https://doi.org/10.1093/qjmed/hcy198 DISCLOSURES: No relevant relationships by Katherine Acosta No relevant relationships by Chika Winifred Akabusi No relevant relationships by Uma Medapati No relevant relationships by Hector Ojeda-Martinez No relevant relationships by Busala Oke No relevant relationships by Mar o Torres

14.
Chest ; 162(4):A285, 2022.
Article in English | EMBASE | ID: covidwho-2060550

ABSTRACT

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Beyond conventional risk factors, studies suggest acute viral infections, including influenza, are a potential risk factor for development of acute cardiovascular (CV) related events such as acute coronary syndrome (ACS) and stroke. On Mar 31st, 2020, the Texas state governor instated a shelter-in-place or quarantine order. With social distancing and masking the exposure respiratory viral illnesses dropped. This study seeks to evaluate the impact of reduced viral infections on CV related events. METHODS: A retrospective chart review of patients admitted to 18 affiliated Baylor Scott & White Texas hospitals in north and central Texas from January 20th, 2020 to Jun 1st, 2020 and between January 20th, 2019 to Jun 1st, 2019. We defined the pre-quarantine period as January 20, 2020 – March 31, 2020. The quarantine period was defined as April 1, 2020 – Jun 1st, 2020. We investigated ACS and stroke risk associated with lab-confirmed respiratory virus panel- PCR (RVP) positivity using a self-controlled case series. RVP positivity was reviewed to determine the presence or absence of increased risk interval. Risk intervals were identified as 7 days after respiratory specimen collection and associated control intervals were one year before and one year after the risk intervals. RESULTS: There were 3,782 patients who had ACS or stroke from January 20th, 2020 to June 1st, 2020. Average monthly rate of positive viral infection was significantly lower during the state mandate social distancing period than before social distancing mandate (5.5 ± 4.6 vs 19.7 ± 4.2, p<0.0001). During the prequarantine period, for stroke, there was a significant difference in positive RVP between the prequarantine and quarantine period (10.8% vs 0%, P=0.009). For ACS, there was a significant difference in positive RVP between the prequarantine and quarantine period (16.2% vs 1%, P<0.001). Rhinovirus infections accounted for 67% of patients of stroke prequarantine. Influenza accounted for 40% of infections in patients with ACS. Admissions for CV related events were higher in the pre-quarantine period compared to the quarantine period (893 vs 695 strokes;1,227 vs 967 ACS). Patients in the pre-quarantine and quarantine were similar in age and gender. For stroke, there was no significant difference in the type of stroke between the two time periods with ischemic stroke occurring in 67% of patients. For ACS, there was no significant difference in type with non ST-elevation MI occurring in 44% of patients. There was no statistical difference of survival to discharge or readmission at 30 days between the two periods. CONCLUSIONS: In our multicenter study, we note significant decline in cardiovascular events due to viral illness. This study strengthens the association between viral infections and cardiovascular events. CLINICAL IMPLICATIONS: This study reveals implications of cardiovascular events following viral illness. DISCLOSURES: No relevant relationships by Tayler Acton no disclosure on file for Alex Arroliga;No relevant relationships by Jason Ettlinger No relevant relationships by Shekhar Ghamande No relevant relationships by Mufaddal Mamawala No relevant relationships by Abirami Subramanian No relevant relationships by Heath White

15.
Journal of Comprehensive Pediatrics ; 13(Supplement 1):32-33, 2022.
Article in English | EMBASE | ID: covidwho-2058676

ABSTRACT

Upper respiratory tract infection (URI) is one of the most frequent diseases observed at centers for pediatric care and results in significant morbidity worldwide. URI is the most common cause in children treated against acute respiratory infection. The difficulty found by clinicians in establishing the differential and etiologic diagnosis of URIs and the occasionally indiscriminate use of antimicrobial drugs. URIs range from the common, cold-typically a mild, self-limited, catarrhal syndrome of the nasopharynx to life-threatening illnesses such as epiglottitis. Viruses account for most URIs. Appropriate management in these cases may consist of reassurance, education, and instructions for symptomatic home treatment. Diagnostic tests for specific agents are helpful when targeted URI therapy depends on the results. Bacterial primary infection or superinfection may require targeted therapy. The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx, gateways to the trachea, bronchi, and pulmonary alveolar spaces. Rhinitis, pharyngitis, sinusitis, epiglottitis, laryngitis, and tracheitis are specific manifestations of URIs. Most URIs are viral in origin. Typical viral agents that cause URIs include the Rhinoviruses, Coronaviruses, Adenoviruses, and Coxsackieviruses. In the emergency department, attention should be paid to the patient's vital signs, including temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation (if obtained). Neonates are obligate nose breathers and may be at greater risk for respiratory distress;hence practitioners should auscultate the lungs for adequate aeration and assess breathing quality. The cardiovascular examination should assess adequate distal perfusion and an appropriate-for-age heart rate. Finally, dehydration can be a complication of any viral illness, and therefore, an assessment of hydration should be a part of the initial evaluation. Tests of nasopharyngeal specimens for specific pathogens are helpful when targeted therapy depends on the results (e.g., group A streptococcal infection, gonococcus, pertussis). Specific bacterial or viral testing is also warranted in other selected situations, such as when patients are immunocompromised, during inevitable outbreaks, or provide specific therapy to contacts. Symptombased therapy represents the mainstay of URI treatment in immunocompetent adults. Antimicrobial or antiviral therapy is appropriate in selected patients.

16.
Open Microbiology Journal ; 16(1), 2022.
Article in English | Scopus | ID: covidwho-2054695

ABSTRACT

This letter briefly presents the relationships between respiratory viruses in the years prior to and during the COVID-19 pandemic. Viral common colds are self-limiting infections that typically resolve within a few days. However, when well-established epidemiological relationships are disrupted during a pandemic, they behave differently. For instance, during the 2009 influenza pandemic, while the majority of seasonal respiratory viruses lost ground under the pressure of a new pandemic strain, some others (for instance, human rhinoviruses) continued to circulate along with the pandemic pathogen and in some cases, even delayed its spread. With the arrival of the COVID-19 pandemic, the degree of circulation of many respiratory viruses has changed dramatically. Along with a significant reduction in the circulation of many seasonal respiratory pathogens, rhinoviruses, respiratory syncytial virus and non-COVID-19 coronaviruses—being the most frequently identified respiratory pathogens—have shown their unique capability to compete with SARS-CoV-2. © 2022 Kiseleva et al.

17.
Emerg Infect Dis ; 28(10): 2096-2099, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2054893

ABSTRACT

We performed prospective studies on respiratory viral infections among Team Finland participants during the 2021 Oberstdorf World Ski Championships and the 2022 Beijing Olympic Games. We enrolled 73 athletes and 110 staff members. Compared with similar studies we conducted before the COVID-19 pandemic, illnesses and virus detections dropped by 10-fold.


Subject(s)
COVID-19 , Viruses , Athletes , COVID-19/epidemiology , Humans , Pandemics , Prospective Studies
18.
Pathogens ; 11(10)2022 Sep 23.
Article in English | MEDLINE | ID: covidwho-2043893

ABSTRACT

(1) Background: Massive social efforts to prevent the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have affected the epidemiological features of respiratory infections. (2) Methods: The study aims to describe the trend of hospitalizations for bronchiolitis among newborns and infants up to three months of life in Rome (Italy), in the pre-COVID-19 era and during the pandemic. (3) Results: We observed a marked decrease in the number of neonates and infants with bronchiolitis after national lockdowns in 2020 and the first months of 2021 and a similar trend in the number of bronchiolitis caused by respiratory syncytial virus (RSV). RSV was the leading pathogen responsible for bronchiolitis before the national lockdown in March 2020 (70.0% of cases), while Rhinovirus was the leading pathogen responsible for bronchiolitis (62.5%) during the pandemic while strict restrictions were ongoing. As Italy approached the COVID-19 vaccination target, the national government lifted some COVID-19-related restrictions. A surprising rebound of bronchiolitis (particularly cases caused by RSV) was observed in October 2021. (4) Conclusions: In this study, we describe for the first time the fluctuations over time of RSV bronchiolitis among newborns and young infants in Italy in relation to the restrictive measures containing the spread of the COVID-19 pandemic. Our results are in line with other countries' reports.

19.
Russian Journal of Infection & Immunity ; 12(4):624-638, 2022.
Article in Russian | Academic Search Complete | ID: covidwho-2040494

ABSTRACT

Acute respiratory viral infections are distributed across the globe and are the most numerous human diseases caused by several hundreds of diverse viruses. Human rhinovirus is one of the most common respiratory pathogens worldwide, causing more than half of all acute respiratory viral infection cases. Seasonal human coronaviruses account for 10 -15% of common cold cases;respiratory syncytial (RS) virus is the most common cause of respiratory hospitalization in infants;influenza viruses, adenoviruses, human parainfluenza virus, metapneumoviruses, and some other pathogens are also widespread. It is believed that viral common colds are mostly self-limited, causing mild infections that usually resolve within 8–10 days. However, the role of common seasonal respiratory viruses in total respiratory morbidity should not be underestimated. It turned out that during extraordinary conditions of pandemics, they behave differently. This was clearly demonstrated in the last 2009 influenza pandemic. Whereas some viruses lost relevance under the burden of a new aggressive pandemic strain, others, e.g., rhinovirus, continued to fight for existence and not only circulated along with the pandemic pathogen, but delayed its spread in some cases. For instance, the data from some European countries pointed out that the circulation of the H1N1pdm09 influenza A pandemic virus was interrupted by the annual rhinovirus outbreak. Ten years after the H1N1pdm09 influenza pandemic, a new virus outbreak emerged - the COVID-19 pandemic has begun. This pandemic, caused by the SARS-CoV-2 virus, has disrupted well-established pathogenetic and epidemiological relationships. The level of circulation of many respiratory pathogens has changed dramatically. For instance, global influenza activity has been at a much lower level than expected for the second year from now. In many regions of the world, the flu season has not been started yet. But what is interesting is that rhinoviruses together with RS-virus again showed their unique ability to compete with highly pathogenic and aggressive pathogens. Along with profoundly reduced circulation of many other seasonal respiratory viruses, rhinovirus, and RS-virus are the most frequently detected viruses. In this review, we have brought together the main biological characteristics of such genetically distinct viruses such as rhinovirus, influenza A virus, RS-virus, and SARS-CoV-2. We focused on their main similarities and discrepancies in the attempt to understand why they behave so differently in extreme pandemic conditions as well as what allows rhinoviruses and RSviruses to coexist with SARS-CoV-2, which in turn almost fully replaced the influenza virus. (English) [ FROM AUTHOR] Острые респираторные вирусные инфекции являются самыми многочисленными заболеваниями человека, с развитием которых связывают несколько сотен различных вирусов. Один из наиболее распространенных на планете респираторных патогенов -это риновирус человека, который является причиной более половины всех случаев острых респираторных вирусных инфекций;на долю сезонных коронавирусов человека приходится 10–15% простудных заболеваний;респираторно-синцитиальный (РС) вирус -наиболее частая причина госпитализации младенцев с респираторными заболеваниями;также широко распространены вирусы гриппа, аденовирусы, вирус парагриппа человека и метапневмовирусы. Считается, что вирусные простудные заболевания-это в основном самостоятельно купирующиеся, легко протекающие инфекции, которые обычно проходят в течение 8–10 дней. Однако не стоит недооценивать роль обычных сезонных респираторных вирусов в общей массе респираторных патогенов. Оказалось, что в экстраординарных условиях пандемий они ведут себя по-разному. Это было очень четко продемонстрировано в последнюю пандемию гриппа 2009 г. Если одни вирусы под гнетом агрессивного пандемического штамма сдали свои позиции, то другие, и ярким тому примером может служить риновирус,- продолжали активно бороться за существование и не только циркулировали наравне с пандемическим патогеном, но и в ряде случаев задерживали его распространение. Так происходило, например, в ряде европейских стран, где наступление пандемического вируса гриппа H1N1pdm09 было приостановлено начавшейся ежегодной осенней вспышкой риновирусной инфекции. Спустя десять лет от начала пандемии гриппа H1N1pdm09 разразилась пандемия COVID-19, вызванная новым коронавирусом SARS-CoV-2. Эта пандемия нарушила устоявшиеся эпидемиологические и патогенетические взаимосвязи. Уровень циркуляции многих респираторных патогенов значительно изменился. Например, глобальная активность гриппа уже второй год находится на гораздо более низком уровне, чем ожидалось. Вомногих регионах мира сезон гриппа так и не начался. Но что интересно: риновирусы, а с ними и РС-вирус, снова проявили свою уникальную способность конкурировать с высокопатогенными и агрессивными возбудителями. При значительном сокращении циркуляции мн ¾Ð³Ð¸Ñ… сезонных респираторных вирусов, именно риновирус и РС-вирус оказались наиболее часто обнаруживаемыми вирусами. Ð’ настоящем обзоре мы свели воедино основные биологические характеристики таких генетически удаленных вирусов, как риновирус, вирус гриппа А, РС-вирус и SARS-CoV-2, в попытке понять, что их объединяет и разделяет, почему так по-разному они ведут себя в экстремальных пандемических условиях и что позволяет риновирусам и РС-вирусам сосуществовать с SARSCoV-2, который, в свою очередь, почти полностью вытеснил вирус гриппа. (Russian) [ FROM AUTHOR] Copyright of Russian Journal of Infection & Immunity is the property of National Electronic-Information Consortium and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

20.
Journal of Biotech Research ; 13:177-188, 2022.
Article in English | ProQuest Central | ID: covidwho-2033805

ABSTRACT

The 3C protease is distinguished from most proteases due to the presence of cysteine nucleophile that plays an essential role in viral replication. This peculiar structure encompassed with its role in viral replication has promoted 3C protease as an interesting target for therapeutic agents in the treatment of diseases caused by human rhinovirus (HRV). However, the molecular mechanisms surrounding the chirality of inhibitors of HRV 3C protease remain unresolved. Herein using in silico techniques such molecular dynamic simulation and binding free estimations via molecular mechanics poisson-boltzmann surface area (MM/PBSA), we present a comprehensive molecular dynamics study of the comparison of two potent inhibitors, SG85 and rupintrivir, complexed with HRV3C protease. The binding free energy studies revealed a higher binding affinity for SG85 of 58.853 kcal/mol than that for rupintrivir of 54.0873 kcal/mol and this was found to be in correlation with the experimental data. The energy decomposition analysis showed that residues Leu 127, Thr 142, Ser 144, Gly 145, Tyr 146, Cys 147, His 161, Val 162, Gly 163, Gly 164, Asn 165, and Phe 170 largely contributed to the binding of SG85, whereas His 40, Leu 127, and Gly 163 impacted the binding of rupintrivir. The results further showed that His 40, Glu 71, Leu 127, Cys 147, Gly 163, and Gyl 164 were crucial residues that played a key role in ligand-enzyme binding, and amongst these crucial residues, His 40, Glu 71, and Cys 147 appeared to be conserved in the active site of HRV-3C protease when bound by both inhibitors. These findings provided a comprehensive understanding of the dynamics and structural features and would serve as guidance in the design and development of potent novel inhibitors of HRV.

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