Influenza A infections: predictors of disease severity.

Influenza affects approximately 10% of the world's population annually. It is associated with high morbidity and mortality rates due to its propensity to progress to severe acute respiratory infection, leading to 10-40% of hospitalized patients needing intensive care. Characterizing the multifactorial predictors of poor prognosis is essential for developing strategies against this disease. This study aimed to identify predictors of disease severity in influenza A-infected (IFA-infected) patients and to propose a prognostic score. A retrospective cross-sectional study was conducted with 142 IFA-infected out- and inpatients treated at a tertiary hospital between 2010 and 2018. The viral subtypes, hemagglutinin mutations, viral load, IL-28B SNPs, and clinical risk factors were evaluated according to the patient's ICU admission. Multivariate analysis identified the following risk factors for disease severity: neuromuscular diseases (OR = 7.02; 95% CI = 1.18-41.75; p = 0.032), cardiovascular diseases (OR = 5.47; 95% CI = 1.96-15.27; p = 0.001), subtype (H1N1) pdm09 infection (OR = 2.29; 95% CI = 1.02-5.15; p = 0.046), and viral load (OR = 1.43; 95% CI = 1.09-1.88; p = 0.009). The prognosis score for ICU admission is based on these predictors of severity presented and ROC curve AUC = 0.812 (p < 0.0001). Our results identified viral and host predictors of disease severity in IFA-infected patients, yielding a prognostic score that had a high performance in predicting the IFA patients' ICU admission and better results than a viral load value alone. However, its implementation in health services needs to be validated in a broader population.

Standardization of a high-performance RT-qPCR for viral load absolute quantification of influenza A.

Influenza is an acute viral infectious respiratory disease worldwide, presenting in different clinical forms, from influenza-like illness (ILI) to severe acute respiratory infection (SARI). Although real-time quantitative polymerase chain reaction (qPCR) is already an important tool for both diagnosis and treatment monitoring of several viral infections, the correlation between the clinical aspects and the viral load of influenza is still unclear. This lack of clarity is primarily due to the low accuracy and reproducibility of the methodologies developed to quantify the influenza virus. Thus, this study aimed to develop and standardize a universal absolute quantification for influenza A by reverse transcription-quantitative PCR (RT-qPCR), using a plasmid DNA. The assay showed efficiency (Eff%) 98.6, determination coefficient (R2) 0.998, linear range 10^1 to 10^10, limit of detection (LOD) 6.77, limit of quantification (LOQ) 20.52 copies/reaction. No inter and intra assay variability was shown, and neither was the matrix effect observed. Serial measurements of clinical samples collected at a 72h interval showed no change in viral load. By contrast, immunocompetent patients have a significantly lower viral load than immunosuppressed ones. Absolute quantification in clinical samples showed some predictors associated with increased viral load: (H1N1)pdm09 (0.045); women (p = 0.049) and asthmatics (p = 0.035). The high efficiency, precision, and previous performance in clinical samples suggest the assay can be used as an accurate universal viral load quantification of influenza A. Its applicability in predicting severity and response to antivirals needs to be evaluated.

Human metapneumovirus infection in hematopoietic stem cell transplant recipients.

UNLABELLED: Human metapneumovirus (hMPV) was described in 2001 and has been associated with both upper and lower respiratory tract infection (URTI and LRTI, respectively), especially in children, the elderly, and in immunocompromised patients. The objective of this study was to identify hMPV as the etiological agent of acute respiratory infection in hematopoietic stem cell transplant (HSCT) patients and to determine the clinical features of hMPV infection in these patients. METHODS: The study was performed retrospectively in 769 respiratory samples obtained from immunocompromised patients submitted to HSCT over a period of 6 years. RNA was extracted by the guanidinium thiocyanate method, and reverse transcription polymerase chain reaction assay was performed to amplify a 928pb fragment of the hMPV N gene. RESULTS: hMPV was present in 19 (2.5%) samples. The mean age of infected patients was 18.3+/-10.8 (range, 3-41). Sixty-six percent of hMPV infections occurred during autumn, winter, and spring months. Three episodes showed co-infection with more than 1 virus. Two patients (11.1%) were infected a few days into the conditioning period and 9 (50%) in the first 3 months after the transplant. The majority of patients (72.2%) presented URTI alone with flu-like symptoms (cough, fever, headache, wheezing), while 5 patients (27.8%) had LRTI (pneumonia). No patient died from complications associated with the hMPV infection. CONCLUSIONS: hMPV has been reported as a respiratory pathogen in HSCT patients. We suggest that hMPV infection should be routinely investigated in this population, mainly in children, to prevent nosocomial transmission during transplant proceedings and to avoid the risk of progressing to complications due to LRTI.

Impact of respiratory infections by influenza viruses A and B in pediatrics patients from Federal University of Paraná, Brazil.

The objective of the present study was to determine the impact of influenza virus on pediatric hospitalized patients. We retrospectively reviewed records of children with laboratory diagnoses, by cell culture and/or indirect immunofluorescence assay, of influenza virus seen in a period of 6 years. A total of 1,033 samples were analyzed, 45 (4.3%) of them being reactive to influenza virus. Thirty-one samples were positive to influenza A virus and 14 to influenza B. The frequency of hospitalization in intensive care and medical emergency was found to be high. Three (8.6%) patients died, two of them due to respiratory failure. Low frequency of influenza virus infection was observed in the study. The data suggest the need of more efficient epidemiological surveillance measures in order to obtain reliable information to better assess the impact of the virus on our region and determine the need of preventive measures, such as immunization.

Impact of respiratory infections by influenza viruses A and B in pediatrics patients from Federal University of Paraná, Brazil

The objective of the present study was to determine the impact of influenza virus on pediatric hospitalized patients. We retrospectively reviewed records of children with laboratory diagnoses, by cell culture and/or indirect immunofluorescence assay, of influenza virus seen in a period of 6 years. A total of 1,033 samples were analyzed, 45 (4.3 percent) of them being reactive to influenza virus. Thirty-one samples were positive to influenza A virus and 14 to influenza B. The frequency of hospitalization in intensive care and medical emergency was found to be high. Three (8.6 percent) patients died, two of them due to respiratory failure. Low frequency of influenza virus infection was observed in the study. The data suggest the need of more efficient epidemiological surveillance measures in order to obtain reliable information to better assess the impact of the virus on our region and determine the need of preventive measures, such as immunization.

Características epidemiológicas del embarazo en la adolescencia: estudio en la maternidad escuela de Fortaleza/Brasil / Characteristic epidemiologists of pregnancy in the adolescence: study in the maternity Fortaleza/Brasil school

Objetivo: analizar características epidemiológicas del embarazo en la adolescencia y comparar las variables entre las gestantes precoces y tardías. Pacientes y Métodos: en un estudio transversal, analítico, se evaluaron 2.058 prontuarios, 322 (15,65 por ciento) del grupo de las precoces y 1.736 (84,35 por ciento) de las tardías, que tuvieron su parto en la Maternidad Escuela Assis Chateaubriand /UFC del 01/01/2000 al 31/12/2000. Resultados: del total de partos, el 25,95 por ciento eran adolescentes. Promedio de edad fue de 17,19 años; 35,50 por ciento de las gestantes se declararon sin pareja (p=0,017). Escolaridad, el 15,83 por ciento eran analfabetas o poseían la escuela primaria incompleta y 29,68 por ciento declaraban 8 o más años de estudio (p=0,0001). El consumo de cigarrillo, alcohol y drogas ilícitas fue bajo y sin diferencia estadística entre los dos grupos de edad. Hubo un gran número de primigestas, 73,06 por ciento. Reincidencia de gestaciones, 6,83 por ciento en las precoces y 30,67 por ciento en las tardías (p<0,0001). Los índices de aborto, 4,04 por ciento entre las de menor edad y 8,43 por ciento en las de mayor edad (p=0,033). Conclusiones: El índice de embarazo en la adolescencia fue elevado y el número de partos creció, en la medida en que aumentó la edad materna. Las adolescentes se caracterizaron por: la mayoría declaró estar con pareja, tener escolaridad media y presentar bajo consumo de cualquier tipo de droga. La incidencia de primigestas fue elevada y la mayoría no declaró aborto anterior.

Padronizaçäo da técnica antigenemia para a detecçäo do citomegalovirus / Padronization of antigenemia metodology for detection of citomegalovirus

Antigenemia para citomegalovirus (CMV) é um importante marcador de evoluçäo de doença e eficácia de tratamento em pacientes imunocomprometidos. O objetivo desse estudo foi comparar diferentes técnicas de processamentos e de imunomarcaçäo para a detecçäo da proteína da matrix do CMV pp65 em leucócitos do sangue periférico. Amostras de sangue coletadas de pacientes submetidos ao transplante de medula óssea (TMO) foram processadas e imunomarcadas por diferentes metodologias. Separou-se leucócitos de sangue periférico, utilizando-se duas técnicas, sedimentaçäo espontânea a 37§C (Processamento 1) e a sedimentaçäo com Dextran (Processamento 2), após a lise eritrocitária procedeu-se a contagem dos leucócitos, ajuste da densidade celular e o preparo das lâminas que continham (2x10 a quinta potência) células, por citocentrifugaçäo. As lâminas, obtidas através das diferentes técnicas de processamentos, foram coradas, utilizando-se a metodologia de Imunoperoxidase (IP) e os resultados obtidos foram analisados de acordo com parâmetros qualitativos e quantitativos. Também avaliou-se duas diferentes técnicas de imunomarcaçäo: IFI Imunofluorescência Indireta) e IP onde comparou-se o número de células positivas. Obteve-se lâminas de melhor qualidade pelo processamento 1 e um maior número de célu;as positivas com técnica de IP

Infecçäo por parvovirus: apresentaçäo atípica em três crianças / Infection due to parvovirus: atypical clinical aspects in three children

Os autores descrevem três casos de infecçäo causada por Parvovirus em escolares com apresentaçäo clínica atípica. Aspectos relativos ao exantema, enfartamento ganglionar, hepatomegalia, e outros comemorativos foram distintos do observado no eritema infeccioso classicamente descrito. Os autores ressaltam a dificuldade no diagnóstico e o significado dos achados frente as recentes descriçöes de quadros graves causados por Parvovirus