ABSTRACT
A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.
Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.
Subject(s)
Influenza, Human , Humans , Mexico/epidemiology , Influenza, Human/epidemiology , Pandemics , Government , Referral and ConsultationABSTRACT
Resumen Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.
Abstract A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.
ABSTRACT
Erythrostemon yucatanensis (Greenm.) Gagnon & GP Lewis is a legume tree native to and widely distributed in southeast Mexico, where its branches are used in traditional medicine. An in vitro evaluation of the antiviral activity of extracts and fractions from the leaves, stem bark and roots against two strains of the AH1N1 influenza virus was performed, leading to the identification of bioactive compounds in this medicinal plant. In a cytopathic effect reduction assay, the fractions from the leaves and stem bark were the active elements at the co-treatment level. These were further fractionated based on their hemagglutination inhibition activity. The analysis of spectroscopy data identified a combination of phytosterols (ß-sitosterol, stigmasterol and campesterol) in the stem bark active fraction as the main anti-hemagglutinin binding components, while 5-hydroxy-2(2-hydroxy-3,4,5-trimethoxyphenyl)-7-metoxi-4H(chromen-4-ona), which was isolated from the leaf extracts, showed a weak inhibition of viral hemagglutinin. Time of addition experiments demonstrated that the mixture of sterols had a direct effect on viral particle infectivity at the co-treatment level (IC50 = 3.125 µg/mL). This effect was also observed in the virus plaque formation inhibition assay, where the mixture showed 90% inhibition in the first 20 min of co-treatment at the same concentration. Additionally, it was found using qRT-PCR that the NP copy number was reduced by 92.85% after 60 min of co-treatment. These results are the first report of components with anti-hemagglutinin binding activity in the genus Erythrostemon sp.
Subject(s)
Fabaceae , Influenza A Virus, H1N1 Subtype , Influenza A virus , Influenza, Human , Antiviral Agents/chemistry , Biological Assay , Hemagglutinins , Humans , Plant Extracts/chemistryABSTRACT
Interferon-induced transmembrane (IFITM) proteins mediate protection against enveloped viruses by blocking membrane fusion at endosomes. IFITM1 and IFITM3 are crucial for protection against influenza, and various single nucleotide polymorphisms altering their function have been linked to disease susceptibility. However, bulk IFITM1 and IFITM3 mRNA expression dynamics and their correlation with clinical outcomes have not been extensively addressed in patients with respiratory infections. In this study, we evaluated the expression of IFITM1 and IFITM3 in peripheral leukocytes from healthy controls and individuals with severe pandemic influenza A(H1N1) or coronavirus disease 2019 (COVID-19). Comparisons between participants grouped according to their clinical characteristics, underlying disease, and outcomes showed that the downregulation of IFITM1 was a distinctive characteristic of severe pandemic influenza A(H1N1) that correlated with outcomes, including mortality. Conversely, increased IFITM3 expression was a common feature of severe pandemic influenza A(H1N1) and COVID-19. Using a high-dose murine model of infection, we confirmed not only the downregulation of IFITM1 but also of IFITM3 in the lungs of mice with severe influenza, as opposed to humans. Analyses in the comparative cohort also indicate the possible participation of IFITM3 in COVID-19. Our results add to the evidence supporting a protective function of IFITM proteins against viral respiratory infections in humans.
Subject(s)
Antigens, Differentiation , COVID-19 , Influenza, Human , Membrane Proteins , RNA-Binding Proteins , Animals , Antigens, Differentiation/genetics , Antigens, Differentiation/metabolism , COVID-19/genetics , Humans , Influenza A Virus, H1N1 Subtype , Influenza, Human/genetics , Leukocytes/metabolism , Membrane Proteins/genetics , Membrane Proteins/metabolism , Mice , RNA-Binding Proteins/genetics , RNA-Binding Proteins/metabolismABSTRACT
Background: Emerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines the effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics. Methods: We conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect the effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS). Findings: Over this 38-year study, the MMR decreased by 58·6% (69·5 to 28·8 deaths/100,000 live births), transitioning from direct obstetric causes (67·0 to 21·1/100,000 live births; 68·4% decrease) to indirect causes (2·6 to 7·7/100,000 live births; 196·2% increase). The regression analysis showed an average reduction of -2·2%/year (95% CI: -2·9 to -1·4) with 2 join points in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from the respiratory system- and sepsis-related complications (level change 4·7 and 1·6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities. Interpretation: The Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from the respiratory system- and sepsis-related complications. Funding: Supported by FISAR www.fisarchile.org.
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Abstract: Objective: To compare the perceptions and experiences between the A(H1N1) and Covid-19 pandemics in a university population. Materials and methods: Online surveys were administered during the influenza A(H1N1) -originated in Mexico in 2009- and Covid-19 epidemics. Measures: sociodemographic characteristics, knowledge, information and communication, perception of risk, physical and mental health, effects on daily life, and preventive behaviors. Results: This study included 24 998 respondents, 51.36% from the A(H1N1) group and 48.63% from the Covid-19 group. Differences were observed in the perception of severity. During the influenza A(H1N1) pandemic worry was the feeling reported most frequently, while for Covid-19 it was anxiety. Covid-19 had greater impact on students' family economy and caused a higher uncertainty. Conclusions: The perceptions and experiences of the two pandemics were similar but the impact has been much greater for Covid-19, especially in terms of the severity, family economy, preventive behaviors, and uncertainty.
Resumen: Objetivo: Comparar las experiencias y percepciones de riesgo entre las pandemias de A(H1N1) y Covid-19 en universitarios. Material y métodos: Encuestas en línea comparables de las epidemias de influenza A(H1N1) -originada en México en 2009- y Covid-19. Evaluaciones: características sociodemográficas, conocimientos, información y comunicación, percepción de riesgo, salud física y mental, efectos en la vida cotidiana, conductas preventivas. Resultados: Participaron 24 998 sujetos; 51.36% de grupo de A(H1N1) y 48.63% del grupo de Covid-19. Se observaron diferencias en la percepción de las epidemias. En influenza A(H1N1) la preocupación fue el sentimiento más frecuente y para Covid-19, la ansiedad. En Covid-19 hubo mayor impacto en la economía familiar y mayor incertidumbre para el regreso a clases. Conclusión: Las percepciones y experiencias de las dos pandemias fueron similares, pero el impacto ha sido mucho mayor para Covid-19 especialmente en la gravedad, economía familiar, conductas preventivas y en la incertidumbre.
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Influenza A virus (IAV) infection is a common cause of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Since macrophage inflammatory protein 1 α, a chemokine that acts through CC-chemokine receptor (CCR)-5, appears elevated in COPD patients' airways, we evaluated whether CCR5 antagonist Maraviroc could inhibit the exacerbated lung inflammatory response noted after IAV H1N1 infection in mice exposed to cigarette smoke (Cs). C57BL/6 mice, subjected or not to Cs inhalation for 11 days, were infected with H1N1 at day 7. Maraviroc (10 mg/kg) or dexamethasone (1 mg/kg) were given in a therapeutic schedule, followed by the analyses of lung function, survival rate, and inflammatory changes. As compared to mice subjected to Cs or H1N1 alone, the insult combination significantly worsened airway obstruction, neutrophil infiltration in the airways, and the survival rate. All changes were sensitive to Maraviroc but not dexamethasone. Maraviroc also reduced the accumulation of neutrophils and macrophages as well as CXCL1 production in the lung tissue, and serum levels of IL-6, whereas comparable viral titers in the lungs were noted in all infected groups. Collectively, these findings suggest that Maraviroc oral treatment could be an effective therapy for controlling acute exacerbations of respiratory diseases such as COPD.
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[This corrects the article DOI: 10.3389/fimmu.2021.633297.].
ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a global health threat with the potential to cause severe disease manifestations in the lungs. Although COVID-19 has been extensively characterized clinically, the factors distinguishing SARS-CoV-2 from other respiratory viruses are unknown. Here, we compared the clinical, histopathological, and immunological characteristics of patients with COVID-19 and pandemic influenza A(H1N1). We observed a higher frequency of respiratory symptoms, increased tissue injury markers, and a histological pattern of alveolar pneumonia in pandemic influenza A(H1N1) patients. Conversely, dry cough, gastrointestinal symptoms and interstitial lung pathology were observed in COVID-19 cases. Pandemic influenza A(H1N1) was characterized by higher levels of IL-1RA, TNF-α, CCL3, G-CSF, APRIL, sTNF-R1, sTNF-R2, sCD30, and sCD163. Meanwhile, COVID-19 displayed an immune profile distinguished by increased Th1 (IL-12, IFN-γ) and Th2 (IL-4, IL-5, IL-10, IL-13) cytokine levels, along with IL-1ß, IL-6, CCL11, VEGF, TWEAK, TSLP, MMP-1, and MMP-3. Our data suggest that SARS-CoV-2 induces a dysbalanced polyfunctional inflammatory response that is different from the immune response against pandemic influenza A(H1N1). Furthermore, we demonstrated the diagnostic potential of some clinical and immune factors to differentiate both diseases. These findings might be relevant for the ongoing and future influenza seasons in the Northern Hemisphere, which are historically unique due to their convergence with the COVID-19 pandemic.
Subject(s)
COVID-19 , Cytokines , Influenza A Virus, H1N1 Subtype , Influenza, Human , Matrix Metalloproteinase 1 , Matrix Metalloproteinase 3 , Receptors, Immunologic , Adult , Aged , COVID-19/blood , COVID-19/epidemiology , COVID-19/immunology , Cytokines/blood , Cytokines/immunology , Female , Humans , Influenza A Virus, H1N1 Subtype/immunology , Influenza A Virus, H1N1 Subtype/metabolism , Influenza, Human/blood , Influenza, Human/epidemiology , Influenza, Human/immunology , Male , Matrix Metalloproteinase 1/blood , Matrix Metalloproteinase 1/immunology , Matrix Metalloproteinase 3/blood , Matrix Metalloproteinase 3/immunology , Middle Aged , Prospective Studies , Receptors, Immunologic/blood , Receptors, Immunologic/immunology , Th1 Cells/immunology , Th2 Cells/immunologyABSTRACT
The differentiation between influenza and coronavirus disease 2019 (COVID-19) could constitute a diagnostic challenge during the ongoing winter owing to their clinical similitude. Thus, novel biomarkers are required to enable making this distinction. Here, we evaluated whether the surfactant protein D (SP-D), a collectin produced at the alveolar epithelium with known immune properties, was useful to differentiate pandemic influenza A(H1N1) from COVID-19 in critically ill patients. Our results revealed high serum SP-D levels in patients with severe pandemic influenza but not those with COVID-19. This finding was validated in a separate cohort of mechanically ventilated patients with COVID-19 who also showed low plasma SP-D levels. However, plasma SP-D levels did not distinguish seasonal influenza from COVID-19 in mild-to-moderate disease. Finally, we found that high serum SP-D levels were associated with death and renal failure among severe pandemic influenza cases. Thus, our studies have identified SP-D as a unique biomarker expressed during severe pandemic influenza but not COVID-19.
Subject(s)
COVID-19/genetics , Gene Expression , Host-Pathogen Interactions/genetics , Influenza A Virus, H1N1 Subtype , Influenza, Human/genetics , Pulmonary Surfactant-Associated Protein D/genetics , SARS-CoV-2 , Adult , Aged , Biomarkers , COVID-19/blood , COVID-19/diagnosis , COVID-19/virology , Coinfection , Enzyme-Linked Immunosorbent Assay , Female , Humans , Influenza, Human/diagnosis , Influenza, Human/virology , Male , Middle Aged , Prognosis , Pulmonary Surfactant-Associated Protein D/blood , Severity of Illness Index , Symptom Assessment , Young AdultABSTRACT
The C-X-C motif chemokine ligand 17 (CXCL17) is chemotactic for myeloid cells, exhibits bactericidal activity, and exerts anti-viral functions. This chemokine is constitutively expressed in the respiratory tract, suggesting a role in lung defenses. However, little is known about the participation of CXCL17 against relevant respiratory pathogens in humans. Here, we evaluated the serum levels and lung tissue expression pattern of CXCL17 in a cohort of patients with severe pandemic influenza A(H1N1) from Mexico City. Peripheral blood samples obtained on admission and seven days after hospitalization were processed for determinations of serum CXCL17 levels by enzyme-linked immunosorbent assay (ELISA). The expression of CXCL17 was assessed by immunohistochemistry (IHQ) in lung autopsy specimens from patients that succumbed to the disease. Serum CXCL17 levels were also analyzed in two additional comparative cohorts of coronavirus disease 2019 (COVID-19) and pulmonary tuberculosis (TB) patients. Additionally, the expression of CXCL17 was tested in lung autopsy specimens from COVID-19 patients. A total of 122 patients were enrolled in the study, from which 68 had pandemic influenza A(H1N1), 24 had COVID-19, and 30 with PTB. CXCL17 was detected in post-mortem lung specimens from patients that died of pandemic influenza A(H1N1) and COVID-19. Interestingly, serum levels of CXCL17 were increased only in patients with pandemic influenza A(H1N1), but not COVID-19 and PTB. CXCL17 not only differentiated pandemic influenza A(H1N1) from other respiratory infections but showed prognostic value for influenza-associated mortality and renal failure in machine-learning algorithms and regression analyses. Using cell culture assays, we also identified that human alveolar A549 cells and peripheral blood monocyte-derived macrophages increase their CXCL17 production capacity after influenza A(H1N1) pdm09 virus infection. Our results for the first time demonstrate an induction of CXCL17 specifically during pandemic influenza A(H1N1), but not COVID-19 and PTB in humans. These findings could be of great utility to differentiate influenza and COVID-19 and to predict poor prognosis specially at settings of high incidence of pandemic A(H1N1). Future studies on the role of CXCL17 not only in severe pandemic influenza, but also in seasonal influenza, COVID-19, and PTB are required to validate our results.
Subject(s)
Biomarkers/metabolism , Chemokines, CXC/metabolism , Influenza A Virus, H1N1 Subtype/physiology , Influenza, Human/diagnosis , Lung/metabolism , Mycobacterium tuberculosis/physiology , SARS-CoV-2/physiology , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , Chemokines, CXC/genetics , Chemokines, CXC/immunology , Cohort Studies , Disease Progression , Female , Humans , Influenza, Human/mortality , Lung/pathology , Male , Mexico , Middle Aged , Pandemics , Patient Outcome Assessment , Prognosis , Survival Analysis , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/mortality , Young AdultABSTRACT
(1) Background: The influenza A/H1N1 pdm09 virus rapidly spread throughout the world. Despite the inflammatory and virus-degradation pathways described in the pathogenesis of influenza A virus (IAV) infection, little is known about the role of the single nucleotide polymorphisms (SNPs) in the genes involved in the processing and antigenic presentation-related mechanisms. (2) Methods: In this case-control study, we evaluated 17 SNPs in five genes (TAP1, TAP2, TAPBP, PSMB8, and PSMB9). One hundred and twenty-eight patients with influenza A/H1N1 infection (INF-P) and 111 healthy contacts (HC) were included; all of them are Mexican mestizo. (3) Results: In allele and genotype comparison, the rs241433/C allele (TAP2), as well as AG haplotype (rs3763365 and rs4148882), are associated with reduced risk for influenza A/H1N1 infection (p < 0.05). On the other hand, the rs2071888G allele (TAPBP) and GG haplotype (rs3763365 and rs9276810) are associated with a higher risk for influenza A/H1N1 infection. In addition, after adjustment for covariates, the association to a reduced risk for influenza A/H1N1 infection remains with rs241433/C allele (p < 0.0001, OR = 0.24, 95% CI = 0.13-0.43), and the association with TAPBP is also maintained with the G allele (p = 0.0095, OR = 1.89, 95% CI = 1.17-3.06) and GG genotype models (p < 0.05, OR = 2.18, 95% CI = 1.27-3.74). (4) Conclusion: The rs241433/C allele and AC genotype (TAP2) and the AG haplotype are associated with a reduced risk for influenza A/H1N1 infection. In addition, the rs2071888/G allele and GG genotype (TAPBP) and the GG haplotype are associated with a higher risk for developing influenza A/H1N1 infection in a Mexican mestizo population.
Subject(s)
Antigen Presentation/genetics , Genetic Predisposition to Disease/ethnology , Influenza A Virus, H1N1 Subtype/immunology , Influenza, Human/epidemiology , Polymorphism, Single Nucleotide , Adult , Aged , Aged, 80 and over , Alleles , Case-Control Studies , Female , Genetic Predisposition to Disease/epidemiology , Genotype , Haplotypes , Humans , Influenza, Human/ethnology , Male , Mexico/epidemiology , Middle Aged , Retrospective StudiesABSTRACT
Rationale: Increased IL-8 levels and neutrophil accumulation in the airways are common features found in patients affected by pulmonary diseases such as Asthma, Idiopathic Pulmonary Fibrosis, Influenza-A infection and COPD. Chronic neutrophilic inflammation is usually corticosteroid insensitive and may be relevant in the progression of those diseases. Objective: To explore the role of Ladarixin, a dual CXCR1/2 antagonist, in several mouse models of airway inflammation with a significant neutrophilic component. Findings: Ladarixin was able to reduce the acute and chronic neutrophilic influx, also attenuating the Th2 eosinophil-dominated airway inflammation, tissue remodeling and airway hyperresponsiveness. Correspondingly, Ladarixin decreased bleomycin-induced neutrophilic inflammation and collagen deposition, as well as attenuated the corticosteroid resistant Th17 neutrophil-dominated airway inflammation and hyperresponsiveness, restoring corticosteroid sensitivity. Finally, Ladarixin reduced neutrophilic airway inflammation during cigarette smoke-induced corticosteroid resistant exacerbation of Influenza-A infection, improving lung function and mice survival. Conclusion: CXCR1/2 antagonist Ladarixin offers a new strategy for therapeutic treatment of acute and chronic neutrophilic airway inflammation, even in the context of corticosteroid-insensitivity.
Subject(s)
Neutrophils/immunology , Neutrophils/metabolism , Receptors, Interleukin-8A/antagonists & inhibitors , Receptors, Interleukin-8B/antagonists & inhibitors , Respiratory Tract Diseases/etiology , Respiratory Tract Diseases/metabolism , Sulfonamides/pharmacology , Animals , Anti-Inflammatory Agents/pharmacology , Asthma/drug therapy , Asthma/etiology , Asthma/metabolism , Asthma/pathology , Biomarkers , Biopsy , Bleomycin/adverse effects , Cytokines/metabolism , Disease Models, Animal , Disease Progression , Disease Susceptibility , Eosinophils/immunology , Eosinophils/metabolism , Female , Fibrosis , Immunohistochemistry , Leukocytes , Male , Mice , Mice, Knockout , Ovalbumin/adverse effects , Oxidation-Reduction , Respiratory Hypersensitivity/etiology , Respiratory Hypersensitivity/metabolism , Respiratory Hypersensitivity/pathology , Respiratory Tract Diseases/drug therapy , Respiratory Tract Diseases/pathology , T-Lymphocyte Subsets/drug effects , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolismABSTRACT
Influenza, a zoonosis caused by various influenza A virus subtypes, affects a wide range of species, including humans. Pig cells express both sialyl-α-2,3-Gal and sialyl-α-2,6-Gal receptors, which make them susceptible to infection by avian and human viruses, respectively. To date, it is not known whether wild pigs in Mexico are affected by influenza virus subtypes, nor whether this would make them a potential risk of influenza transmission to humans. In this work, 61 hogs from two municipalities in Campeche, Mexico, were sampled. Hemagglutination inhibition assays were performed in 61 serum samples, and positive results were found for human H1N1 (11.47%), swine H1N1 (8.19%), and avian H5N2 (1.63%) virus variants. qRT-PCR assays were performed on the nasal swab, tracheal, and lung samples, and 19.67% of all hogs were positive to these assays. An avian H5N2 virus, first reported in 1994, was identified by sequencing. Our results demonstrate that wild pigs are participating in the exposure, transmission, maintenance, and possible diversification of influenza viruses in fragmented habitats, highlighting the synanthropic behavior of this species, which has been poorly studied in Mexico.
Subject(s)
Influenza A virus/isolation & purification , Influenza, Human/transmission , Influenza, Human/virology , Orthomyxoviridae Infections/veterinary , Swine Diseases/virology , Animals , Animals, Wild/virology , Hemagglutination Inhibition Tests , Humans , Influenza A Virus, H1N1 Subtype/classification , Influenza A Virus, H1N1 Subtype/genetics , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza A Virus, H5N2 Subtype/classification , Influenza A Virus, H5N2 Subtype/genetics , Influenza A Virus, H5N2 Subtype/isolation & purification , Influenza A virus/classification , Influenza A virus/genetics , Influenza, Human/epidemiology , Lung/pathology , Lung/virology , Mexico/epidemiology , Orthomyxoviridae Infections/epidemiology , Orthomyxoviridae Infections/pathology , Orthomyxoviridae Infections/virology , Swine , Swine Diseases/epidemiology , Swine Diseases/pathology , Swine Diseases/transmission , Trachea/pathology , Trachea/virology , Zoonoses/epidemiology , Zoonoses/transmission , Zoonoses/virologyABSTRACT
Resumen: La miocarditis es una enfermedad inflamatoria del miocardio secundaria a enfermedades autoinmunes, tóxicas e infecciosas. Dentro de éstas últimas, las virales son las más frecuentes. Sin embargo, el virus de influenza A H1N1 sigue siendo una etiología poco reportada. La prevalencia de miocarditis fulminante debido a gripe estacional ha sido establecida entre 1 y 11% según los criterios diagnósticos utilizados, y la prevalencia de miocarditis causada por H1N1 se estima en 13%. Presentamos un caso clínico, de una paciente joven, donde se realiza diagnóstico retrospectivo de Miocarditis por Influenza A H1N1 con presentación de miocarditis fulminante, con alteraciones electrocardiográficas sugestivas, troponinas cardiacas positivas, caída de la función ventricular con posterior recuperación, y aislamiento microbiológico de agente causal.
Abstract: Myocarditis is an inflammatory myocardial disease secondary to autoimmune, toxic, and infectious diseases. Among the latter, virals are the most frequent. However, influenza A H1N1 virus remains a poorly reported etiology. The prevalence of fulminant myocarditis due to seasonal influenza has been established between 1 and 11% according to the diagnostic criteria used, and the prevalence of myocarditis caused by H1N1 is estimated at 13%. We report a clinical case, of a young patient, where a retrospective diagnosis of H1N1 Influenza A myocarditis was made with a presentation of fulminant myocarditis, with suggestive electrocardiographic abnormalities, positive cardiac troponins, loss of ventricular function with subsequent recovery, and microbiological isolation of the causal agent.
Resumo: A miocardite é uma doença inflamatória do miocárdio secundária a doenças autoimunes, tóxicas e infecciosas. Entre os últimos, os virais são os mais frequentes. No entanto, o vírus influenza A H1N1 permanece uma etiologia pouco relatada. A prevalência de miocardite fulminante por influenza sazonal foi estabelecida entre 1 e 11%, de acordo com os critérios diagnósticos utilizados, e a prevalência de miocardite causada pelo H1N1 é estimada em 13%. Apresentamos um caso clínico, de um paciente jovem, em que foi feito um diagnóstico retrospectivo de miocardite por influenza A H1N1, com apresentação de miocardite fulminante, com alterações eletrocardiográficas sugestivas, troponinas cardíacas positivas, perda de função ventricular com recuperação subsequente e isolamento microbiológico do agente causal.
ABSTRACT
BACKGROUND Influenza viral load (VL) can be a decisive factor in determining the antiviral efficacy in viral clearance. OBJECTIVE This study aimed to evaluate the rate of infection and the role of influenza VL on the clinical spectrum of illnesses among different patient groups attended at a tertiary hospital in Brazil. METHODS Samples were collected from patients presenting acute respiratory infection from 2009 to 2013. Overall, 2262 samples were analysed and distributed into three groups: (i) asymptomatic (AS); (ii) symptomatic outpatients (OP); and (iii) hospitalised patients (HP). VL (expressed in Log10 RNA copies/mL) was calculated through a quantitative real-time one-step reverse transcription-polymerase chain reaction (RT-PCR) assay aimed at the M gene, with human RNAseP target as internal control and normalising gene of threshold cycle values. FINDINGS A total of 162 (7.16%) H1N1pdm09 positive samples were analysed. Patients aged from 0.08 to 77 years old [median ± standard deviation (SD): 12.5 ± 20.54]. Children with 5 to 11 years old presented the highest detection (p < 0.0001). AS patients had the lowest VL, with a significant difference when compared with symptomatic patients (p = 0.0003). A higher VL was observed within two days of disease onset. Ten patients (HP group) received antiviral treatment and were followed up and presented a mean initial VL of 6.64 ± 1.82. A complete viral clearance for 50% of these patients was reached after 12 days of treatment. MAIN CONCLUSIONS It is important to evaluate AS patients as potential spreaders, as viral shedding was still present, even at lower VL. Our results suggest that patients with underlying diseases and severe clinical symptoms may be considered for prolonged viral treatment.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Young Adult , Respiratory Tract Infections/virology , Influenza, Human/virology , Influenza A Virus, H1N1 Subtype/genetics , RNA, Viral/genetics , Acute Disease , Viral Load , Influenza A Virus, H1N1 Subtype/classification , Influenza A Virus, H1N1 Subtype/pathogenicity , Real-Time Polymerase Chain Reaction , Middle AgedABSTRACT
The clinical effects and immunological response to the influenza vaccine in women who later become pregnant remain to be thoroughly studied. Here, we report the medical outcomes of 40 women volunteers who became pregnant after vaccination with an experimental virus-like particle (VLP) vaccine against pandemic influenza A(H1N1)2009 (influenza A(H1N1)pdm09) and their infants. When included in the VLP vaccine trial, none of the women were pregnant and were randomly assigned to one of the following groups: (1) placebo, (2) 15 µg dose of VLP vaccine, or (3) 45 µg dose of VLP vaccine. These 40 women reported becoming pregnant during the follow-up phase after receiving the placebo or VLP vaccine. Women were monitored throughout pregnancy and their infants were monitored until one year after birth. Antibody titers against VLP were measured in the mothers and infants at delivery and at six months and one year after birth. The incidence of preeclampsia, fetal death, preterm delivery, and premature rupture of membranes was similar among groups. All vaccinated women and their infants elicited antibody titers (≥1:40). Women vaccinated prior to pregnancy had no adverse events that were different from the nonvaccinated population. Even though this study is limited by the sample size, the results suggest that the anti-influenza A(H1N1)pdm09 VLP experimental vaccine applied before pregnancy is safe for both mothers and their infants.
Subject(s)
Antibodies, Viral/blood , Disease Outbreaks , Influenza A Virus, H1N1 Subtype/immunology , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Pandemics , Vaccination , Adult , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Influenza Vaccines/adverse effects , Influenza, Human/epidemiology , Influenza, Human/virology , Male , Mexico , Pregnancy , Pregnancy Outcome , Vaccines, Virus-Like Particle/immunology , Young AdultABSTRACT
Influenza is a leading cause of respiratory tract infections worldwide and there is limited information on the impact of the influenza A(H1N1)pdm virus on mortality after the 2009 pandemic. Using national mortality register data through 1998-2015 in Mexico, influenza-associated mortality was estimated for respiratory, cardiovascular, and all-cause events. The proportion of influenza-associated respiratory and cardiovascular deaths among different age groups were compared. There were 8,853,986 death registries included for the 1998-2015 winter seasons, average influenza-associated respiratory, cardiovascular, and all-cause mortality rates were 5.2, 6.3, and 19.6 deaths/100,000 population, respectively. The largest number of respiratory influenza-associated deaths occurred in adults 60 years of age and older, followed by children <5 years of age; during the 2009 pandemic, 2011-2012, and 2013-2014 winter seasons there was a larger number of deaths in the 20-59 years old group. Influenza-associated mortality rates showed a continuous reduction in children <5 years of age. After the 2009 pandemic, influenza A(H1N1)pdm09 virus-associated mortality in Mexico showed a persistent change in the demographic pattern of the most severely affected population, particularly during the 2013-2014 season. Influenza associated-mortality has decreased in children <5 years of age and continue to be elevated in adults >60 years of age.
Subject(s)
Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/mortality , Influenza, Human/virology , Age Factors , Humans , Influenza, Human/epidemiology , Mexico/epidemiology , Seasons , Survival AnalysisABSTRACT
We describe three clinical cases of Surinamese children with rhabdomyolysis with diverse clinical presentation and course. The first patient had rhabdomyolysis because of toxins caused by multiple beestings and developed acute kidney injury. The other two patients had rhabdomyolysis following acute infection with chikungunya and influenza A/H1N1 virus. These cases emphasize that the diverse etiology of rhabdomyolysis should be considered in children in tropical settings.
Subject(s)
Bee Venoms/poisoning , Bees , Chikungunya Fever/complications , Influenza, Human/complications , Insect Bites and Stings/complications , Rhabdomyolysis/etiology , Acute Kidney Injury/etiology , Adolescent , Animals , Chikungunya Fever/diagnosis , Chikungunya virus/isolation & purification , Child , Child, Preschool , Humans , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/diagnosis , Male , Rhabdomyolysis/physiopathology , SurinameABSTRACT
BACKGROUND: Influenza is an acute and highly contagious viral respiratory infection that causes significant morbidity and mortality. The identification of host genetic factors associated with susceptibility and severity of influenza virus infection is of paramount importance. Previous studies evaluating the potential involvement of the CCR5Δ32 polymorphism (rs333), a 32 base pair deletion in CC motif chemokine receptor 5 (CCR5) gene, in severity and mortality of influenza A(H1N1)pdm09 infected individuals have been reported, but their results are quite conflicting. OBJECTIVES: The aim of this study was the evaluation of the CCR5Δ32 frequency in individuals with mild, severe and fatal influenza A(H1N1)pdm09 infection and its putative association with clinical and epidemiologic data. PATIENTS/METHODS: A total of 432 individuals were included in this study and classified according to their clinical status, into the following groups: influenza like illness (ILI) (nâ¯=â¯153); severe acute respiratory infection (SARI) (nâ¯=â¯173) and fatal (nâ¯=â¯106) cases. The samples were collected in the post pandemic period, from 2012 to 2018. Individuals were further stratified according to their clinical and epidemiological data. The CCR5Δ32 variant was genotyped by PCR amplification and a subset of samples was further submitted to Sanger sequencing. RESULTS: The different clinical groups (ILI, SARI and fatal) presented similar distribution of wt/wt and wt/Δ32 genotypes and CCR5Δ32 allele frequencies. Genotype Δ32/Δ32 was not detected in our study. Additionally, no association between wt/wt and wt/Δ32 genotypes and dyspnea, a clinical factor for influenza complications was found. Similarly, no significant differences in the distribution of wt/wt and wt/Δ32 genotypes and CCR5Δ32 variant allele frequencies were observed in samples from the different Brazilian geographical regions. CONCLUSIONS: The CCR5Δ32 variant does not influence the susceptibility to influenza A(H1N1)pdm09 severe disease or mortality in individuals from Brazil.