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1.
Crit Care ; 26(1): 11, 2022 01 04.
Article in English | MEDLINE | ID: mdl-34983611

ABSTRACT

BACKGROUND: Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. OBJECTIVES: To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. METHODS: This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. RESULTS: A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53-7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88-5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. CONCLUSIONS: Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693 .


Subject(s)
COVID-19 , Influenza, Human , Intubation , Invasive Pulmonary Aspergillosis , Adult , COVID-19/epidemiology , COVID-19/therapy , Europe/epidemiology , Humans , Incidence , Influenza, Human/epidemiology , Influenza, Human/therapy , Invasive Pulmonary Aspergillosis/epidemiology , Retrospective Studies , SARS-CoV-2
2.
Respir Investig ; 59(6): 748-756, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34481816

ABSTRACT

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a valuable rescue therapy to treat refractory hypoxemia caused by influenza. The present meta-analysis aimed to compare the clinical characteristics and outcomes of ECMO between COVID-19 and influenza. METHODS: We searched the PubMed, Cochrane Library, SCOPUS, and Web of Science databases from inception to May 1, 2021. The included studies compared the clinical characteristics and outcomes of ECMO between adults with COVID-19 and those with influenza. RESULTS: The study included four retrospective cohorts involving a total of 129 patients with COVID-19 and 140 with influenza who were treated using ECMO. Clinical characteristics were similar between the COVID-19 and influenza groups, including body mass index (BMI), diabetes mellitus, hypertension, and immunocompromised status. A higher proportion of patients with COVID-19 on ECMO were male (75.9% vs. 62.9%; P = 0.04). There was no difference between the groups in terms of illness severity based on sequential organ failure assessment (SOFA) score or serum pH. Patients with COVID-19 had a longer mean duration of mechanical ventilation before ECMO (6.63 vs. 3.38 days; P < 0.01). The pooled mortality rate was 43.8%. The mean ECMO duration (14.13 vs. 12.55 days; P = 0.25) and mortality rate (42.6% vs. 45.0%; P = 0.99) were comparable between the groups. CONCLUSION: Clinical characteristics, ECMO duration, and mortality were comparable between patients with COVID-19 and those with influenza who required ECMO to treat refractory hypoxemia. The duration of mechanical ventilation before ECMO did not influence outcomes. Patients with COVID-19 benefit from ECMO salvage therapy similarly to those with influenza.


Subject(s)
COVID-19/complications , Extracorporeal Membrane Oxygenation/adverse effects , Influenza, Human/complications , Pneumonia/therapy , Respiratory Distress Syndrome/therapy , COVID-19/therapy , Humans , Influenza, Human/therapy , Intensive Care Units , Pandemics , Respiratory Distress Syndrome/etiology , SARS-CoV-2 , Treatment Outcome
3.
J Card Surg ; 36(10): 3740-3746, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34369601

ABSTRACT

PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as coronavirus disease 2019 [COVID-19]). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. METHODS: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV-ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. RESULTS: A total of 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p = .04). Thirty days survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p = .13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 vs. 12 days; p = .025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy before ECMO initiation (p < .001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%; p = .03) and bacterial pneumonia (36% vs. 6%; p = .024). CONCLUSIONS: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Influenza, Human , Humans , Influenza, Human/complications , Influenza, Human/therapy , Retrospective Studies , SARS-CoV-2
4.
5.
Am J Case Rep ; 22: e932251, 2021 Aug 02.
Article in English | MEDLINE | ID: mdl-34334786

ABSTRACT

BACKGROUND Thrombotic microangiopathy, characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ damage by microvascular thrombosis, has a high mortality rate; therefore, early diagnosis and treatment are important. Thrombotic thrombocytopenic purpura is caused by a deficiency of a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13), and results in thrombotic microangiopathy. Influenza virus causes thrombotic thrombocytopenic purpura by inducing immunoglobulin G autoantibodies against ADAMTS13. We report a rare case of thrombotic thrombocytopenic purpura caused by influenza A without anti-ADAMTS13 antibody that was treated by plasma exchange. CASE REPORT A 57-year-old woman was admitted to our hospital because of hypoxemia. We diagnosed pneumonia and disseminated intravascular coagulation. Despite treatment, she developed thrombocytopenia, and we diagnosed thrombotic microangiopathy and started plasma exchange. With a PLASMIC score of 6 points and neuropsychiatric symptoms, we strongly suspected thrombotic thrombocytopenic purpura and started rituximab. However, ADAMTS13 activity by FRETS-VWF73 assay was 65%, and anti-ADAMTS13 antibody was negative. After 4 plasma exchanges and 2 rounds of rituximab, platelet numbers and lactate dehydrogenase and creatinine concentrations normalized on the 16th day of hospitalization. Subsequently, influenza A (H1N1) was identified in a nasopharyngeal swab collected on admission. Plasma enzyme-linked immunosorbent assay testing for chromogenic ADAMTS13 activity showed a significant decrease (<0.5%). Therefore, we diagnosed thrombotic thrombocytopenic purpura caused by influenza A without anti-ADAMTS13 antibody. CONCLUSIONS We present a rare case of thrombotic thrombocytopenic purpura without anti-ADAMTS13 antibody caused by influenza A virus successfully treated by plasma exchange. Influenza A may reduce ADAMTS13 activity without inducing autoantibodies.


Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza A virus , Influenza, Human , Purpura, Thrombotic Thrombocytopenic , Female , Humans , Influenza, Human/complications , Influenza, Human/therapy , Middle Aged , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy
6.
Med Intensiva (Engl Ed) ; 45(6): 347-353, 2021.
Article in English | MEDLINE | ID: mdl-34294232

ABSTRACT

OBJECTIVE: To evaluate the risk factors associated to noninvasive mechanical ventilation (NIV) failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus admitted to the intensive care unit (ICU), and to demonstrate the association of NIV failure to increased mortality and longer stays. DESIGN: A cohort study was carried out. SCOPE: A mixed ICU (16 beds) in a teaching hospital. PATIENTS: Adult patients admitted to the ICU with a diagnosis of pneumonia due to influenza A (H1N1)pdm09 virus requiring mechanical ventilation. MEASUREMENTS: Age, sex, severity scores, administration of corticosteroids, oseltamivir within 72h of symptoms onset, days of symptoms prior to admission, affected quadrants, hemodynamic parameters, renal failure, laboratory test data on admission, mortality and stay in ICU and in hospital. RESULTS: A total of 54 patients were admitted to the ICU and 49 were ventilated; 29 were females (59.2%), and the mean age±standard deviation was 66.77±14.77 years. Forty-three patients (87.75%) were ventilated with NIV, and 18 (41.9%) of them failed. Patients with NIV failure were younger (63 vs. 74 years; p=0.04), with a higher SOFA score (7 vs. 4; p=0.01) and greater early hemodynamic failure (61.1 vs. 8%; p=0.01). In addition, they presented longer ICU (26.28 vs. 6.88 days; p=0.01) and hospital stay (32.78 vs. 18.8 days; p=0.01). The ICU mortality rate was also higher in the NIV failure group (38.9 vs. 0%; p=0.02). In the multivariate analysis, corticosteroid therapy (OR 7.08; 95% CI 1.23-40.50) and early hemodynamic failure (OR 14.77; 95% CI 2.34-92.97) were identified as independent risk factors for NIV failure. CONCLUSIONS: Treatment with corticosteroids and early hemodynamic failure were associated to NIV failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus infection admitted to the ICU. The failure of NIV was associated to increased mortality.


Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza, Human , Noninvasive Ventilation , Pneumonia , Adult , Aged , Aged, 80 and over , Cohort Studies , Critical Care , Female , Hospital Mortality , Humans , Influenza, Human/therapy , Middle Aged , Risk Factors
7.
PLoS One ; 16(7): e0253161, 2021.
Article in English | MEDLINE | ID: mdl-34292983

ABSTRACT

OBJECTIVES: Respiratory syncytial virus (RSV) can cause severe disease in adults, but far less is known than for influenza. The aim of our study was to compare the disease course of RSV infections with influenza infections among hospitalized adults. METHODS: We retrieved clinical data from an ongoing surveillance of adults hospitalized with RSV or influenza virus infection in two acute care hospitals in North-Eastern Switzerland during the winter seasons 2017/2018 and 2018/2019. Our main analysis compared the odds between RSV and influenza patients for admission to an intensive care unit (ICU) or in-hospital death within 7 days after admission. RESULTS: There were 548 patients, of whom 79 (14.4%) had an RSV and 469 (85.6%) an influenza virus infection. Both groups were similar with respect to age, sex, smoking status, nutritional state, and comorbidities. More RSV patients had an infiltrate on chest radiograph on admission (46.4% vs 29.9%, p = .007). The proportion of patients with RSV who died or were admitted to ICU within seven days after admission was 19.0% compared to 10.2% in influenza patients (p = .024). In multivariable analysis, a higher leukocyte count (adjusted OR 1.07, 95% CI 1.02-1.13, p = .013) and the presence of a pneumonic infiltrate (aOR 3.41, 95% CI 1.93-6.02) significantly increased the risk for experiencing the adverse primary outcome while the effect of the underlying viral pathogen became attenuated (aOR 1.18, 95% CI 0.58-2.41, p = .0.655). CONCLUSIONS: Our results suggest that RSV is responsible for clinical courses at least as severe as influenza in adults. This supports the need for better guidance on diagnostic strategies as well as on preventive and therapeutic measures for hospitalized adults with RSV infection.


Subject(s)
Hospitalization/statistics & numerical data , Influenza, Human/therapy , Respiratory Syncytial Virus Infections/therapy , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Female , Hospital Mortality , Humans , Influenza, Human/mortality , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Respiratory Syncytial Virus Infections/mortality , Respiratory Syncytial Viruses , Retrospective Studies , Switzerland/epidemiology , Treatment Outcome , Young Adult
8.
J Med Virol ; 93(12): 6619-6627, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34289142

ABSTRACT

Both severe acute respiratory syndrome coronavirus 2 and influenza viruses cause similar clinical presentations. It is essential to assess severely ill patients presenting with a viral syndrome for diagnostic and prognostic purposes. We aimed to compare clinical and biochemical features between pneumonia patients with coronavirus disease 2019 (COVID-19) and H1N1. Sixty patients diagnosed with COVID-19 pneumonia and 61 patients diagnosed with influenza pneumonia were hospitalized between October 2020-January 2021 and October 2017-December 2019, respectively. All the clinical data and laboratory results, chest computed tomography scans, intensive care unit admission, invasive mechanical ventilation, and outcomes were retrospectively evaluated. The median age was 65 (range 32-96) years for patients with a COVID-19 diagnosis and 58 (range 18-83) years for patients with influenza (p = 0.002). The comorbidity index was significantly higher in patients with COVID-19 (p = 0.010). Diabetes mellitus and hypertension were statistically significantly more common in patients with COVID-19 (p = 0.019, p = 0.008, respectively). The distribution of severe disease and mortality was not significantly different among patients with COVID-19 than influenza patients (p = 0.096, p = 0.049).). In comparison with inflammation markers; C-reactive protein (CRP) levels were significantly higher in influenza patients than patients with COVID-19 (p = 0.033). The presence of sputum was predictive for influenza (odds ratio [OR] 0.342 [95% confidence interval [CI], 2.1.130-0.899]). CRP and platelet were also predictive for COVID-19 (OR 4.764 [95% CI, 1.003-1.012] and OR 0.991 [95% CI 0.984-0.998], respectively. We conclude that sputum symptoms by itself are much more detected in influenza patients. Besides that, lower CRP and higher PLT count would be discriminative for COVID-19.


Subject(s)
COVID-19/pathology , Influenza, Human/pathology , Adolescent , Adult , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19/diagnostic imaging , COVID-19/therapy , Female , Hospitalization , Humans , Influenza A Virus, H1N1 Subtype , Influenza, Human/diagnostic imaging , Influenza, Human/therapy , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Radiography, Thoracic , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Tomography, X-Ray Computed , Young Adult
9.
BMC Infect Dis ; 21(1): 673, 2021 Jul 10.
Article in English | MEDLINE | ID: mdl-34246228

ABSTRACT

BACKGROUND: Due to lack of proven therapies, we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children. METHODS: A single-center, retrospective, cohort study was conducted in Luoyang, Henan province, China from January 2018 to January 2020. Children (<18 years) with influenza-associated neurological disease were enrolled in the study. Children with indications for CBP and parental consent received CBP (Continuous Blood purification), while others received maximal intensive care treatment because of the absence of parental consent. The outcomes of the CBP and non-CBP groups were compared. Categorical variables were presented as percentage and compared by Chi-square test. Continuous variables were expressed as median (interquartile ranges) and compared with non-parametric independent sample test. Statistical analyses were carried out by SPSS (version 26.0) and p < 0.05 (2 tailed) was considered to be statistically significant. RESULTS: 30 children with influenza-associated neurological disease were recruited to the study. 18 received CBP and the other 12 received maximal intensive care. There were no differences between CBP and non-CBP children in age, sex, body weight, type of influenza virus, neurological complications, Glasgow score, PIM-2 score and PCIS at admission (p > 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In the CBP group, there was a significant decrease in IL-6 levels at 3 days of admission (p = 0.003) and a decrease in CRP and PCT levels, but no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on levels of CRP, PCT and IL-6 at admission and 3-day of admission (p > 0.05). The 28-day mortality was significantly lower in the CBP group compared with the non-CBP group (11.11% vs. 50%, p = 0.034). CONCLUSIONS: CBP definitely reduces IL-6 levels significantly. We did find that the survival rate of patients in the CBP group was improved. But we don't know if there is a relationship between the reduction of IL-6 levels and the survival rate. TRIAL REGISTRATION: http://www.chictr.org.cn/index.aspx (ChiCTR2000031754).


Subject(s)
Hemofiltration , Influenza, Human/complications , Nervous System Diseases/therapy , Child, Preschool , China , Cohort Studies , Hospitalization , Humans , Infant , Influenza, Human/therapy , Male , Nervous System Diseases/virology , Prognosis , Retrospective Studies , Survival Rate
10.
Obstet Gynecol ; 138(2): 218-227, 2021 08 01.
Article in English | MEDLINE | ID: mdl-34237767

ABSTRACT

OBJECTIVE: To characterize trends of an influenza diagnosis at delivery hospitalization and its association with severe maternal morbidity. METHODS: We conducted a repeated cross-sectional analysis of delivery hospitalizations using the Nationwide Inpatient Sample from 2000 to 2018. We assessed the association between an influenza diagnosis at delivery hospitalization and severe maternal morbidity excluding transfusion per Centers for Disease Control and Prevention criteria. Secondary outcomes included maternal death and morbidity measures associated with influenza (mechanical intubation and ventilation, sepsis and shock, and acute respiratory distress syndrome [ARDS]) and obstetric complications (preterm birth and hypertensive disorders of pregnancy). We assessed trends of severe maternal morbidity by annual influenza season and the association between influenza and severe maternal morbidity using multivariable log-linear regression, adjusting for demographic, clinical, and hospital characteristics. RESULTS: Of 74.7 million delivery hospitalizations, 23 per 10,000 were complicated by an influenza diagnosis. The rate of severe maternal morbidity was higher with an influenza diagnosis compared with those without influenza (86-410 cases vs 53-70 cases/10,000 delivery hospitalizations). Women with an influenza diagnosis at delivery hospitalization were at an increased risk of severe maternal morbidity compared with those without influenza (2.3 vs 0.7%; adjusted risk ratio 2.24, 95% CI 2.17-2.31). This association held for maternal death, mechanical intubation, sepsis and shock, and ARDS-as well as obstetric complications, including preterm birth and hypertensive disorders of pregnancy. CONCLUSION: Pregnant women with influenza are at increased risk of severe maternal morbidity, as well as influenza-related maternal and obstetric complications. These results emphasize the importance of primary prevention and recognition of influenza infection during pregnancy to reduce downstream maternal morbidity and mortality.


Subject(s)
Delivery, Obstetric , Hospitalization , Influenza, Human/complications , Maternal Mortality , Pregnancy Complications, Infectious/virology , Adult , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Influenza, Human/diagnosis , Influenza, Human/therapy , Morbidity , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Premature Birth , United States/epidemiology
11.
Rev Bras Ter Intensiva ; 33(2): 320-324, 2021.
Article in Portuguese, English | MEDLINE | ID: mdl-34231814

ABSTRACT

We report a case of Influenza B infection and Kawasaki disease in an adolescent, diagnosed during the COVID-19 pandemic. An asthmatic female adolescent presented with fever and flu-like symptoms for 7 days and was admitted with acute respiratory failure requiring mechanical ventilation. She progressed with hemodynamic instability responsive to vasoactive drugs. Antibiotic therapy and support measures were introduced, showing progressive hemodynamics and respiratory improvement, however with persistent fever and increased inflammatory markers. During the hospitalization, she developed bilateral non-purulent conjunctivitis, hand and feet desquamation, strawberry tongue, and cervical adenopathy, and was diagnosed with Kawasaki disease. She was prescribed intravenous immunoglobulin and, due to the refractory clinical conditions, corticosteroid therapy was added; 24 hours later, the patient was afebrile. No coronary changes were found. A full viral panel including COVID-19 C-reactive protein and serology could only isolate the Influenza B virus. During the hospitalization, she was diagnosed with pulmonary thromboembolism; coagulopathies were investigated, and she was diagnosed with heterozygous factor V Leiden mutation. There is a potential association between Kawasaki disease and infection with Influenza B or with other viruses such as coronavirus. Therefore, this association should be considered in pediatric patients, adolescents included, with prolonged febrile conditions.


Subject(s)
COVID-19 , Influenza, Human/diagnosis , Mucocutaneous Lymph Node Syndrome/diagnosis , Respiratory Insufficiency/diagnosis , Adolescent , Female , Hospitalization , Humans , Influenza B virus/isolation & purification , Influenza, Human/therapy , Mucocutaneous Lymph Node Syndrome/complications , Respiration, Artificial , Respiratory Insufficiency/etiology
13.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(6): 523-524, 2021 Jun 12.
Article in Chinese | MEDLINE | ID: mdl-34102712
14.
J Investig Med High Impact Case Rep ; 9: 23247096211016228, 2021.
Article in English | MEDLINE | ID: mdl-33978499

ABSTRACT

Spontaneous pneumomediastinum is reported in patients with coronavirus disease-2019 (COVID-19) and influenza infection independently, usually associated with noninvasive and mechanical ventilation. We report a case of spontaneous pneumomediastinum in a patient with COVID-19 and influenza coinfection. A 58-year-old male admitted with shortness of breath, diagnosed with COVID-19 and influenza infection. A computed tomography angiogram showed pneumomediastinum. He was treated conservatively with 15 L of oxygen, remdesivir, convalescent plasma, and oseltamivir. The case is being reported for its uniqueness since this is the first documented case of spontaneous pneumomediastinum in COVID-19 and influenza coinfection.


Subject(s)
COVID-19/complications , Influenza, Human/complications , Mediastinal Emphysema/virology , Pneumonia, Viral/complications , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/therapy , Coinfection , Combined Modality Therapy , Drug Therapy, Combination , Humans , Immunization, Passive , Influenza, Human/diagnosis , Influenza, Human/therapy , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , Middle Aged , Oxygen Inhalation Therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2
16.
World J Pediatr ; 17(3): 272-279, 2021 06.
Article in English | MEDLINE | ID: mdl-33970449

ABSTRACT

BACKGROUND: It had been documented in many studies that pediatric coronavirus disease 2019 (COVID-19) is characterized by low infectivity rates, low mortalities, and benign disease course. On the other hand, influenza type A viruses are recognized to cause severe and fatal infections in children populations worldwide. This study is aimed to compare the clinical and laboratory characteristics of COVID-19 and H1N1 influenza infections. METHODS: A retrospective study comprising 107 children hospitalized at Abha Maternity and Children Hospital, Southern region of Saudi Arabia, with laboratory-confirmed COVID-19 and H1N1 influenza infections was carried out. A complete follow-up for all patients from the hospital admission until discharge or death was made. The clinical data and laboratory parameters for these patients were collected from the medical records of the hospital. RESULTS: Out of the total enrolled patients, 73 (68.2%) were diagnosed with COVID-19, and 34 (31.8%) were diagnosed with H1N1 influenza. The median age is 12 months for COVID-19 patients and 36 months for influenza patients. A relatively higher number of patients with influenza had a fever and respiratory symptoms than COVID-19 patients. In contrast, gastrointestinal symptoms were observed in a higher number of COVID-19 patients than in influenza patients. A statistically significant increase in white cell counts is noted in COVID-19 but not in influenza patients (P < 0.05). There are no obvious variations in the mean period of duration of hospitalization between COVID-19 and influenza patients. However, the total intensive care unit length of stay was longer for influenza compared to COVID-19 patients. CONCLUSIONS: A considerable number of children infected with COVID-19 and H1N1 influenza were noted and reported in this study. There were no significant variations in the severity of the symptomatology and laboratory findings between the two groups of patients. Significant differences between these patients in some hospitalization factors and diagnosis upon admission also were not observed. However, more severe clinical manifestations and serious consequences were observed among pediatric patients hospitalized with influenza infections than among those with COVID-19.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Child, Hospitalized , Influenza, Human/etiology , Influenza, Human/therapy , Female , Humans , Infant , Influenza A Virus, H1N1 Subtype , Influenza, Human/virology , Length of Stay/statistics & numerical data , Male , Prognosis , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology , Severity of Illness Index
17.
Rev. patol. respir ; 23(4): 127-133, oct.-dic. 2020. tab
Article in Spanish | IBECS | ID: ibc-201104

ABSTRACT

OBJETIVO: La gripe es una enfermedad muy prevalente y es responsable anualmente de entre 3 y 5 millones de casos graves, que llevan a 0,3-0,6 millones de muertes y cuantiosas pérdidas económicas. Por ello, es importante analizar qué factores, complicaciones u otro tipo de características podrían existir en los pacientes ingresados por gripe que pudiesen relacionarse con la mortalidad. MÉTODOS: Estudio unicéntrico, observacional, transversal y retrospectivo de los pacientes ingresados por gripe en el Hospital Universitario La Paz en las temporadas 2013-2014 y 2014-2015, con análisis de las variables recogidas en el documento del historial clínico y de los documentos de declaración obligatoria. RESULTADOS: 16 pacientes fallecieron de los 179 ingresados por gripe en las temporadas 2013-14 y 2014-15, lo que supone un 8,9%. Los fallecidos tenían mayor edad y algún tipo de inmunodeficiencia previa. Once tuvieron neumonía, cinco distrés respiratorio, siete fallo multiorgánico y cuatro de ellos ingresaron en la Unidad de Cuidados Intensivos. Además, la duración del tratamiento antiviral fue menor en comparación con los enfermos vivos al alta. Únicamente seis estaban vacunados. Según el análisis multivariante, la edad avanzada, cualquier tipo de inmunodeficiencia, el desarrollo de neumonía y el distrés respiratorio fueron factores asociados de forma independiente a la mortalidad. CONCLUSIONES: La edad avanzada, el padecimiento de cualquier tipo de inmunodeficiencia, el desarrollo de neumonía y de síndrome de distrés respiratorio agudo constituyeron factores de riesgo independientes para la mortalidad en enfermos ingresados por gripe


BACKGROUND: Influenza is a highly prevalent disease and is responsible of three to five million cases of severe illness every year, leading to 0.3-0.6 million of deaths and important health costs. Therefore, it is important to analyze which factors, complications and other characteristics could be related with patients admitted with flu who die. METHODS: Single-center, observational, cross-sectional and retrospective study of patients admitted with influenza at La Paz University Hospital during 2013-2014 and 2014-2015 seasons, with analysis of the variables collected in the clinical history and in the documents of "notifiable diseases". RESULTS: 16 patients admitted with influenza out of 179 died in the 2013-14 and 2014-15 seasons, which represent 8.9%. These were older patients, and more frequently suffered from some type of immunodeficiency. Eleven had pneumonia, five respiratory distress, seven multi-organ failure and four of them were admitted to the Intensive Care Unit. The duration of antiviral treatment was shorter in the living patients at discharge. Only six were vaccinated. According to the multivariate analysis, advanced age, suffering from any type of immunodeficiency, the development of pneumonia and respiratory distress are factors independently associated with mortality. CONCLUSIONS: Advanced age, suffering from any type of immunodeficiency, the development of pneumonia and respiratory distress are independent risk factors for mortality in patients admitted with influenza


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Influenza, Human/mortality , Hospital Mortality/trends , Cross-Sectional Studies , Retrospective Studies , Influenza, Human/complications , Risk Factors , Intensive Care Units/statistics & numerical data , Influenza, Human/therapy , Chronic Disease , Bolivia/epidemiology
19.
Medicine (Baltimore) ; 100(17): e25716, 2021 Apr 30.
Article in English | MEDLINE | ID: mdl-33907160

ABSTRACT

ABSTRACT: Although influenza is generally an acute, self-limited, and uncomplicated disease in healthy children, it can result in severe morbidity and mortality. The objectives of this study were to analyze and compare the clinical features and outcome of severe pediatric influenza with and without central nervous system (CNS) involvement.We conducted a retrospective observational study of children admitted to the pediatric intensive care unit (PICU) of China Medical University Children's Hospital in Taiwan with a confirmed diagnosis of influenza. The demographic data, clinical and laboratory presentations, therapeutic strategies, and neurodevelopmental outcomes for these patients were analyzed. Furthermore, comparison of patients with and without CNS involvement was conducted.A total of 32 children with severe influenza were admitted during the study periods. Sixteen children were categorized as the non-CNS (nCNS) group and 16 children were categorized as the CNS group. Nine of them had underlying disease. The most common complication in the nCNS group was acute respiratory distress syndrome, (n = 8/16), followed by pneumonia (n = 7/16, 44%). In the CNS group, the most lethal complication was acute necrotizing encephalopathy (n = 3/16) which led to 3 deaths. The overall mortality rate was higher in the CNS group (n = 6) than in the nCNS group (n = 1) (37.5% vs 6.25%, P = .03).The mortality rate of severe complicated influenza was significantly higher with CNS involvement. Children with primary cardiopulmonary abnormalities were at high risk of developing severe complicated influenza, while previously healthy children exhibited risk for influenza-associated encephalitis/encephalopathy.


Subject(s)
Encephalitis, Viral , Influenza, Human , Intensive Care Units, Pediatric/statistics & numerical data , Neurodevelopmental Disorders , Central Nervous System/virology , Child , Encephalitis, Viral/diagnosis , Encephalitis, Viral/etiology , Encephalitis, Viral/mortality , Female , Humans , Influenza A virus/isolation & purification , Influenza, Human/epidemiology , Influenza, Human/physiopathology , Influenza, Human/therapy , Influenza, Human/virology , Male , Mortality , Neurodevelopmental Disorders/diagnosis , Neurodevelopmental Disorders/epidemiology , Neurodevelopmental Disorders/etiology , Outcome and Process Assessment, Health Care , Retrospective Studies , Risk Factors , Severity of Illness Index , Taiwan/epidemiology
20.
Crit Care Med ; 49(7): e663-e672, 2021 07 01.
Article in English | MEDLINE | ID: mdl-33861545

ABSTRACT

OBJECTIVES: Extracorporeal membrane oxygenation is a lifesaving therapy for patients with severe acute respiratory distress syndrome refractory to conventional mechanical ventilation. It is frequently complicated by both thrombosis and hemorrhage. A markedly prothrombotic state associated with high rates of venous thromboembolism has been described in patients with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) infection. These rates have currently not been described during extracorporeal membrane oxygenation in comparison to other viral pneumonias. DESIGN: Retrospective observational study. SETTING: Single high-volume tertiary critical care department at a university hospital. PATIENTS: Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between March 1, 2020, and May 31, 2020, with coronavirus disease 2019 were compared with a cohort of patients with influenza pneumonia between June 1, 2012, and May 31, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The rates of venous thromboembolism and hemorrhage were compared in patients with coronavirus disease 2019 against a historic population of patients with influenza pneumonia who required extracorporeal membrane oxygenation. There were 51 patients who received extracorporeal membrane oxygenation due to coronavirus disease 2019 and 80 patients with influenza. At cannulation for extracorporeal membrane oxygenation, 37% of patients with coronavirus disease 2019 compared with 8% of patients with influenza had filling defects on CT pulmonary angiography (p = 0.0001). Catheter-associated deep vein thrombosis shown on ultrasound Doppler after decannulation was present in 53% with coronavirus disease 2019 versus 25% with influenza (p = 0.01). The rates of intracranial hemorrhage at the time of cannulation were 16% with coronavirus disease 2019 and 14% with influenza (p = 0.8). Elevated d-dimer levels were seen in both conditions and were significantly higher in those with pulmonary thromboembolism than those without in coronavirus disease 2019 (p = 0.02). Fibrinogen and C-reactive protein levels were significantly higher in those with coronavirus disease 2019 than influenza (p < 0.01). CONCLUSIONS: Significant rates of pulmonary thromboembolism and of catheter-associated deep vein thrombosis were seen in both viral infections but were greater in those requiring the use of extracorporeal membrane oxygenation in coronavirus disease 2019 than for influenza.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation , Influenza, Human/therapy , Intracranial Hemorrhages/complications , Pulmonary Embolism/complications , Venous Thromboembolism/complications , Venous Thrombosis/complications , Adult , C-Reactive Protein/metabolism , Computed Tomography Angiography , Female , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Humans , Influenza A Virus, H1N1 Subtype , Influenza A virus , Influenza B virus , London/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , State Medicine , Tertiary Care Centers , Ultrasonography, Doppler
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