Overnutrition as a risk factor for more serious respiratory viral infections in children: A retrospective study in hospitalized patients.

BACKGROUND: The prevalence of obesity has increased dramatically in children worldwide. Obesity has been recognized as a risk factor for more serious viral respiratory infections, mainly in adults. OBJECTIVE: To study the relationship between overnutrition (obesity and overweight) and clinical severity in children hospitalized with acute respiratory infections of viral origin. METHODS: One hundred and forty-three clinical records of children between 2 and 18 years old hospitalized for acute respiratory infection at Clínica Dávila (2014-2018) were analyzed, recording the respiratory viruses detected at the time of hospitalization, weight, and height. Nutritional status was estimated using Z score or body mass index, according to age. RESULTS: Eighty-tree3 children (58%) were positive for more than one respiratory virus. The main virus detected in monoinfection was adenovirus (9.8%), followed by respiratory syncytial virus (7.7%) and parainfluenza virus (7.7%). There were no deaths. Patients with obesity presented more days of hospitalization (P = .04), oxygen therapy (P = .03) and mechanical ventilation (P < .001), as well as a higher probability of requiring mechanical ventilation (P = .001) and of ICU admission (P = .003) compared with children with normal weight. Patients with overweight presented more days of mechanical ventilation (P < .001) than patients with normal weight. No significant differences were found between the presence of viral coinfection and nutritional status. CONCLUSION: Overnutrition is associated with greater severity of viral respiratory infection in hospitalized children.

Complete Genome Characterization of Reticuloendotheliosis Virus Detected in Chickens with Multiple Viral Coinfections.

Reticuloendotheliosis virus (REV) is a retroviral pathogen capable of infecting several avian hosts and is associated with immunosuppression, anemia, proventriculitis, neoplasia, and runting-stunting syndrome. Its genome contains the three major genes, gag, pol, and env, and two flanking long terminal repeat (LTR) regions. Complete genome sequences of REV are limited in terms of geographical origin. The aim of this study was to characterize the complete genome of REV detected in Brazilian chickens with multiple viral coinfections and analyze the polymorphisms in the deduced amino acids sequences corresponding to its encoded proteins. We tested the presence and completeness of REV as well as other viral pathogens in samples from Brazilian poultry farms by qPCR. The complete genomes of two REV strains were sequenced by overlapping fragments through the dideoxy method. Phylogenetic analysis, pairwise identity matrix, polymorphism identification and protein modeling were performed along the entire genome. We detected REV in 65% (26/40) of the tested samples. Concomitant viral infections were detected in 82.5% (33/40) of the samples and in 90% (9/10) of the farms. Multiple infections included up to seven viruses. Phylogenetic analysis classified both Brazilian strains into REV subtype 3, and the pairwise comparison indicated that strains from the USA and fowlpox virus (FWPV)-related strains were the most identical. The subdomain p18 in gag, the reverse transcriptase/ribonuclease H in pol, and the surface (SU) in the env protein were the most polymorphic in genomic comparisons. The relevant motifs for each protein were highly conserved, with fewer polymorphisms in the fusion peptide, immunosuppression domain, and disulfide bonds on the surface (SU) and transmembrane (TM) of env. This is the first study to include complete genomes of REV in Brazil and South America detected in farms with multiple viral coinfections. Our findings suggest an involvement of REV as an immunosuppressor and active agent in the emergence and progression of multiple infectious diseases. We also found a possible etiological relationship between Brazilian strains and the USA and FWPV recombinant strains. This information highlights the need for epidemiological vigilance regarding REV in association with another pathogens.

Overnutrition in Infants Is Associated With High Level of Leptin, Viral Coinfection and Increased Severity of Respiratory Infections: A Cross-Sectional Study.

Objective: To investigate the relationship of overnutrition (obese and overweight) with severity of illness in children hospitalized with acute lower respiratory infections (ALRIs), frequency of viral coinfections and leptin levels. Methods: We studied 124 children <2 years old that were hospitalized for ALRI. Nutritional status was calculated by z-scores according to weight-for-age z-scores, length or height-for-age z-scores, and weight-for-height z-scores. Nasopharyngeal aspirates (NPAs) were obtained and viral respiratory pathogens were identified using reverse transcription polymerase chain reactions (RT-PCR). Respiratory syncytial virus (RSV) load was assessed using quantitative RT-PCR. NPA and plasma leptin level were measured. Clinical data and nutritional status were recorded, and patients were followed up until hospital discharge. Viral coinfection was defined as the presence of two or more viruses detected in the same respiratory sample. Severity of illness was determined by length of hospitalization and duration of oxygen therapy. Results: Children with overnutrition showed a greater frequency of viral coinfection than those with normal weight (71% obese vs. 37% normal weight p = 0.013; 68% overweight vs. 37% normal weight p = 0.004). A lower RSV load was found in obese (5.91 log10 copies/mL) and overweight children (6.49 log10 copies/mL) compared to normal weight children (8.06 log10 copies/mL; p = 0.021 in both cases). In multivariate analysis, obese, and overweight infants <6 months old were associated with longer hospital stays (RR = 1.68; CI: 1.30-2.15 and obese: RR = 1.68; CI: 1.01-2.71, respectively) as well as a greater duration of oxygen therapy (RR = 1.80; IC: 1.41-2.29 and obese: RR = 1.91; CI: 1.15-3.15, respectively). Obese children <6 months showed higher plasma leptin level than normal weight children (7.58 vs. 5.12 ng/µl; p <0.046). Conclusions: In infants younger than 6 months, overnutrition condition was related to increased severity of infections and high plasma leptin level. Also, children with overnutrition showed a greater frequency of viral coinfection and low RSV viral load compared to normal weights children. These findings further contribute to the already existent evidence supporting the importance of overnutrition prevention in pediatric populations.

Aspectos clinicoepidemiológicos en pacientes con coinfección por sida y tuberculosis en la provincia de Santiago de Cuba / Clinical and epidemiological aspects in patients with coinfection due to aids and tuberculosis in Santiago de Cuba province

Se efectuó un estudio descriptivo y retrospectivo de los 15 pacientes con coinfección por sida y tuberculosis en la provincia de Santiago de Cuba, en el período de enero del 2004 a diciembre del 2013, a fin de caracterizarles según algunas variables clinicoepidemiológicas: edad, sexo, comportamiento sexual, formas clínicas y radiológicas de la tuberculosis, conteo de CD4, pruebas microbiológicas del esputo, pruebas inmunológicas y evolución. En la serie resultó superior el total de hombres bisexuales y homosexuales, el diagnóstico de tuberculosis después de 6 meses de completar la quimioprofilaxis, con mayor incidencia de la forma pulmonar de la enfermedad, los rayos X con infiltrado en bases, el conteo de CD4 por debajo de 200 células/mm³, el esputo directo y cultivo negativos, además de la prueba de Mantoux no reactiva. La mayoría de los afectados evolucionó favorablemente y se les dio el alta médica al finalizar el tratamiento y ser curados de tuberculosis.

A descriptive and retrospective study of the 15 patients with coinfection due to AIDS and tuberculosis in Santiago de Cuba province was carried out in the period of January, 2004 to December, 2013, in order to characterize them according to some clinical-epidemiological variables: age, sex, sexual behavior, clinical and radiological features of tuberculosis, CD4 count, sputum microbiological tests, immunological tests and clinical course. In the series the total of bisexual and homosexual men, the tuberculosis diagnosis after 6 months of completing the chemoprophylaxis, with higher incidence in the pulmonary type of the disease, the X rays with base infiltrates, the CD4 count under 200 cells/mm³, the direct sputum and negative culture, besides the non-reactive Mantoux test. Most of the affected patients had a favorable clinical course and they were discharged when concluding the treatment and were cured of tuberculosis.

Coinfección por el virus de la hepatitis C y el virus de la inmunodeficiencia humana en una población de riesgo / Co-infection due to the hepatitis C virus and the human immunodeficiency virus in a population at risk

Se realizó un estudio descriptivo, prospectivo y transversal de 25 pacientes con coinfección por el virus de la hepatitis C y el de la inmunodeficiencia humana, quienes habían sido remitidos al Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" en Santiago de Cuba, en el período de enero del 2012 a igual mes del 2014, a fin de determinar las características epidemiológicas, clínicas y humorales en ellos. En la serie se obtuvo que la infección por ambos virus fuera más frecuente en el grupo etario de 3039 años (36,0 %), en el sexo masculino (96,0 %) y en los integrantes del grupo de múltiples riesgos (64,0 %). La mayoría de los pacientes habían sido diagnosticados con la coinfección en un período inferior a los 3 años, referían más de una manifestación clínica y presentaron resultados elevados en las pruebas funcionales hepáticas.

A descriptive, prospective and cross-sectional study of 25 patients with diagnosis of co-infection due to hepatitis C virus and that of the human immunodeficiency who had been referred to "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, was carried out from January, 2012 to the same month in 2014, in order to determine the epidemiological, clinical and humoral characteristics in them. In the series it was obtained that the infection due to both viruses was more frequent in the 30-39 age group (36.0%), in male sex (96.0%) and in the members of the multiple risks group (64.0%). Most of the patients had been diagnosed with the co-infection in less than the 3 years, they stated more than one clinical feature and presented high results in the liver functional tests.

Impact of Epstein-Barr virus load, virus genotype, and frequency of the 30 bp deletion in the viral BNLF-1 gene in patients harboring the human immunodeficiency virus.

Patients infected with the human immunodeficiency virus (HIV) are at higher risk of developing Epstein-Barr Virus (EBV)-associated lymphomas. The usefulness of monitoring EBV in peripheral blood mononuclear cells (PBMCs) of patients infected with HIV has not been established. The aim of this study was to evaluate the EBV viral load in PBMCs, the frequency of viral genotypes, and the presence of the 30-bp deletion in the BNLF-1 gene. DNA samples from 156 patients attending the HIV/AIDS Day Clinic at Botucatu School of Medicine, Sao Paulo State University were evaluated. The EBV viral load was detectable by real time PCR in 123/156 (78.8%) cases and was higher in patients not receiving antiretroviral treatment or under therapeutic failure than in patients under successful highly active antiretroviral therapy (HAART) (P = 0.0076). Overall, the profile of patients with high EBV viral load included elevated HIV viremia (P = 0.0005), longer time of HIV diagnosis (P = 0.0026), and increased levels of T CD8 (+) lymphocytes (P = 0.0159). The successful amplification of the EBNA-2 gene by nested-PCR was achieved in 95 of 123 (77.2%) cases, of which 75.8% were EBV-1, 9.5% EBV-2, and 14.7% were co-infected with both EBV-1 and -2. The analysis of the BNLF-1 gene was possible in 99 of 123 (80.5%) cases, of which 50.5% had the 30-bp deletion. EBV-1 was more common than EBV-2, which may reflect the fact that the cohort was predominantly Caucasian and heterosexual.

Co-infección viral respiratoria en niños hospitalizados por infección respiratoria aguda y su impacto en la gravedad clínica / Viral respiratory co-infections in pediatric patients admitted for acute respiratory infection and their impact on clinical severity

Introduction: Respiratory viruses are the leading cause of acute respiratory tract infection (ARI) in children. It has been reported that viral respiratory co-infection could be associated with severe clinical course. Objectives: To describe the frequency of viral co-infection in children admitted for AlRI and evaluate whether this co-infection was associated with more severe clinical course. Patients and Methods: Prospective, descriptive study in pediatric patients who were hospitalized for ARI, with molecular detection of at least 1 respiratory virus in nasopharyngeal sample studied by PCR-Microarray for 17 respiratory viruses. Results: 110 out of 147 patients with detection of > 1 respiratory virus were included. Viral co-infection was detected in 41/110 (37%). 22/110 children (20%) were classified as moderate to severe clinical course and 88/110 (80%) were classified as mild clinical course. In the group of moderate to severe clinical course, viral respiratory co-infection was detected in 6/22 (27.3%), compared to 35/88 (39.8 %) in the mild clinical course group. No statistically significant difference was found regarding the presence of co-infection between groups (p = 0.33). Conclusions: We detected high rates of viral co-infection in children with ARI. It was not possible to demonstrate that viral co-infections were related with severe clinical course in hospitalized children.

Introducción: Los virus respiratorios son la principal causa de infección aguda del tracto respiratorio (IRA) en pediatría. Se ha descrito que la co-infección viral podría relacionarse con infecciones virales respiratorias de curso más grave. Objetivo: Describir la frecuencia de co-infección viral en niños hospitalizados por IRA y determinar si esta co-infección se relacionó con una evolución clínica más grave. Pacientes y Métodos: Estudio descriptivo, prospectivo, en pacientes pediátricos hospitalizados por IRA entre junio y agosto 2010, que tuvieron detección molecular de al menos un virus respiratorio en muestra nasofaríngea estudiada por RPC-microarreglo para 17 virus respiratorios. Resultados: Se incluyeron 110 de 147 pacientes con detección de > 1 virus respiratorio. Se detectó co-infección viral en 41/110 (37%). En cuanto a evolución clínica, 22/110 niños (20%) se clasificaron como evolución moderada a grave (MG) y 88/110 (80%) se clasificaron como evolución leve (L). En el grupo MG se detectó co-infección viral respiratoria en 6/22 (27,3%), mientras que en el grupo L se detectó co-infección en 35/88 (39,8%). No se encontró diferencia significativa en relación a la presencia de co-infección entre ambos grupos (p = 0,33). Conclusión: Se demostró la presencia de co-infección viral en un alto porcentaje de niños con IRA. No fue posible demostrar que la presencia de coinfección viral tenga relación con una evolución clínica más grave en estos niños hospitalizados.

Infectious bovine rinotracheitis associated with bovine viral diarrhea and enzootic bovine leukosis / Herpesvírus bovino associado à diarreia viral bovina e à leucose enzoótica bovina

This research verified the variation of the occurrence of herpesvirus bovine type 1 (BoHV-1) by its association with two viral infections: bovine viral diarrhea (BVD) and enzootic bovine leukosis (EBL). The following methodologies were used: virus neutralization test (VNT) for both BoHV-1 and BVD diagnosis, and agar gel immunodiffusion (IDGA) for EBL. Five cattle herds were selected in the states of São Paulo and Minas Gerais, three of them were dairy cattle herds, one beef cattle and one crossbred. Every herd had a number of animals seropositive for BoHV-1. From 278 analyzed samples, 54.68% (152/278) were responsive to BoHV-1, 69.70% (194/278) to BVDV-1, and 34.33% (97/278) to EBLV. The statistical analysis showed significant difference (a = 0.01) in infection occurrence according to the type of herd and animal age. Dairy cattle were more sensitive to BoHV-1 (81.31%) and to EBLV (49.53%), while in beef cattle the most frequent was BVDV-1 (94.74%). Age was a risk factor only for BoHV-1 and EBLV, the results showed that the older animals were more susceptible. The association analysis also indicated that among BVDV-1 and/or EBLV infected herds the probability of finding BoHV-1 is higher than among herds where these two infections do not occur.

Esta pesquisa verificou a variação da ocorrência do herpesvirus bovino tipo 1 (BoHV-1) pela associação com duas doenças virais: diarréia viral bovina (BVD) e leucose enzoótica bovina (LEB). Como metodologias foram utilizados o teste de virusneutralização para detecção de BoHV-1 e BVD, e imunodifusão em gel de ágar para LEB. Foram selecionados cinco rebanhos bovinos, de propriedades localizadas em municípios dos Estados de São Paulo e Minas Gerais, sendo três de exploração leiteira, um de corte e um misto, todos com parte dos animais soropositivos ao BoHV-1. Das 278 amostras analisadas, 54,68% (152/278) foram positivas ao BoHV-1, 69,70% (194/278) ao BVDV-1 e 34,33% (96/278) ao VLEB. Na análise estatística, ao relacionar cada enfermidade com o tipo de exploração do rebanho e a idade dos animais, houve diferença significativa (a=0.01). Os rebanhos leiteiros foram mais suscetíveis ao BoHV-1 (81,31%) e a LEB (49,53%), enquanto o gado de corte teve como maior ocorrência o BVDV-1 (94,74%). A idade foi fator de risco apenas para o BoHV-1 e a LEB, sendo os animais mais velhos os mais suscetíveis. As análises associativas também indicaram que em rebanhos infectados por BVDV-1 e/ou LEB, a probabilidade de se encontrar o BoHV-1 é maior do que nas isentas dessas duas enfermidades.