Respiratory viruses: their importance and lessons learned from COVID-19

Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses

Microbial aetiology of community-acquired pneumonia and its relation to severity

Background: The distribution of the microbial aetiology and mortality of community-acquired pneumonia (CAP) was investigated in relation to the clinical setting and severity scores (pneumonia severity index (PSI) and confusion, blood urea nitrogen, respiratory rate, blood pressure, age (CURB-65)). Methods: 3523 patients with CAP were included (15% outpatients, 85% inpatients). The distribution of the microbial aetiology in relation to the clinical setting and severity scores (PSI, CURB-65) and the relative mortality of different aetiologies across the severity scores were analysed. Results: The aetiology was established in 1463 patients (42%), of whom 257 died (7%). The ranking of aetiologies varied according to site of care, with increasing frequency of Streptococcus pneumoniae and mixed aetiologies and decreasing frequency of atypical pathogens in hospitalised patients and those in ICUs. The distribution of aetiologies according to severity scores showed corresponding patterns; however, the severity scores were more sensitive to Gram-negative enteric bacilli (GNEB) and Pseudomonas aeruginosa and less sensitive in identifying mixed aetiologies as moderate- and high-risk conditions. Mortality rates according to aetiology and severity scoring showed increasing mortality rates for all pathogens except atypical pathogens. S pneumoniae had the highest number of deaths while GNEB, P aeruginosa, Staphylococcus aureus and mixed aetiologies had the highest mortality rates. Legionella pneumophila was similarly distributed according to site of care and prognostic scores. Conclusions: CAP due to atypical bacterial pathogens is recognised both clinically and by severity scoring as a low-risk condition. Severity scores are more sensitive in identifying patients with GNEB and P aeruginosa as moderate- and high-risk aetiologies whereas mixed aetiologies may be underestimated

Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia

Background: Prognostic scales provide a useful tool to predict mortality in community-acquired pneumonia (CAP). However, the inflammatory response of the host, crucial in resolution and outcome, is not included in the prognostic scales. Methods: The aim of this study was to investigate whether information about the initial inflammatory cytokine profile and markers increases the accuracy of prognostic scales to predict 30-day mortality. To this aim, a prospective cohort study in two tertiary care hospitals was designed. Procalcitonin (PCT), C-reactive protein (CRP) and the systemic cytokines tumour necrosis factor alpha (TNFalpha) and interleukins IL6, IL8 and IL10 were measured at admission. Initial severity was assessed by PSI (Pneumonia Severity Index), CURB65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, > or = 65 years of age) and CRB65 (Confusion, Respiratory rate, Blood pressure, > or = 65 years of age) scales. A total of 453 hospitalised CAP patients were included. Results: The 36 patients who died (7.8%) had significantly increased levels of IL6, IL8, PCT and CRP. In regression logistic analyses, high levels of CRP and IL6 showed an independent predictive value for predicting 30-day mortality, after adjustment for prognostic scales. Adding CRP to PSI significantly increased the area under the receiver operating characteristic curve (AUC) from 0.80 to 0.85, that of CURB65 from 0.82 to 0.85 and that of CRB65 from 0.79 to 0.85. Adding IL6 or PCT values to CRP did not significantly increase the AUC of any scale. When using two scales (PSI and CURB65/CRB65) and CRP simultaneously the AUC was 0.88. Conclusions: Adding CRP levels to PSI, CURB65 and CRB65 scales improves the 30-day mortality prediction. The highest predictive value is reached with a combination of two scales and CRP. Further validation of that improvement is needed

Nursing Home-Acquired Pneumonia: a 10 year single-centre experience

Background: Pneumonia among nursing home (NH) residents has increased considerably in recent years, but it remains unclear whether it should be considered as community-acquired pneumonia (CAP) or a new category of infection. Methods 150 consecutive cases of NH-acquired pneumonia (NHAP) (from 1 February 1997 to 1 July 2007) were analysed. Results: Patients (median age, 82 years; range, 77-87 years) showed numerous co-morbidities, (neurological, 55%; pulmonary, 38%; cardiac, 35%) and severe disability for daily activities (partial, 32%; total, 31%). Cases of NHAP were mainly classified as mild to moderate according to the CRB-65 score (CRB-65 classes 0-1 and 2, 41% each). In-hospital and 30-day mortality were 8.7% and 20%, respectively. Aetiology was defined in 57 cases (38%). The most common isolates were Streptococcus pneumoniae (58%), Enterobacteriaceae (Gram-negative bacteria (GNB)) (9%), atypical bacteria (7%), respiratory viruses (5%), methicillin-resistant Staphylococcus aureus (MRSA) (5%) and Legionella pneumophila (5%). The most frequent causes of treatment inadequacy were use of β-lactams alone (25%) and lack of aspiration assessment (15%). Prognostic factors of 1-month mortality were neurological comorbidities (OR 4.5; 95% CI 1.3 to 15.7; p=0.020), septic shock (OR 6.6; 95% CI 1.3 to 34.0; p=0.025), pleural effusion (OR 3.6; 95% CI 1.1 to 11.7; p=0.036) and isolation of GNB or MRSA (OR 16.4; 95% CI 2.1 to 128.9; p=0.008). Conclusions: The patients show clinical characteristics (eg, age and co-morbidities) comparable with those with hospital-acquired pneumonia. However, microbiological and mortality data of patients with NHAP are more similar to the data of those with CAP. Isolation of GNB or MRSA was associated with increased mortality risk. CAP empirical antibiotic coverage is still indicated in NHAP, although specific risk factors for multidrug-resistant infections should be assessed on an individual basis

Cytomegalovirus infection in HIV-infected patients in the era of combination antiretroviral therapy

Background: Cytomegalovirus infection dramatically decreased with the introduction of antiretroviral therapy. Whether incidence, clinical characteristics and prognosis of cytomegalovirus in HIV infected patients, has changed over time is. scarcely known. Methods: Retrospective single-center study. Patients included in this study were all HIV infected patients that went to our center for any disease, and were diagnosed with cytomegalovirus, during the period 2004-2015. epidemiological, clinical and laboratory patients variables were collected in a clinical database. Clinical characteristics, incidence of cytomegalovirus and predictors of mortality during the study were assessed. Results were considered statistically significant when p < 0.05. All statistical analyses were calculated by SPSS version 20.0 (Chicago, IL,USA). Results: Fifty-six cases of cytomegalovirus infection, in HIV infected patients were identified during the study period (incidence rate-1.7 cases per 1000 persons/year). The most frequent presentation was systemic illness in 43% of cases. Of note,no patients presented with ophthalmic manifestations. The 30-days mortality was 18%. Predictors of mortality were, in the univariate analysis, admission to the intensive care unit OR 32.4 (3.65-287.06) p = 0.0001, and mechanic ventilation 84 OR (8.27-853.12) p = 0.0001, and ART OR 4.1 (0.97-17.31) p = 0.044. These variables were assessed by multivariate analysis, and only mechanical ventilation was statistically significant (p < 0.05) CONCLUSION: Incidence of cytomegalovirus infection was higher than described in the antiretroviral therapy era. Clinical presentation has changed. Mechanic ventilation predicted mortality

Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients

Background To evaluate the predictive value of analytical markers of full blood count that can be assessed in the emergency department for HIV infected patients, with community-acquired pneumonia (CAP). Methods Prospective 3-year study including all HIV-infected patients that went to our emergency department with respiratory clinical infection, more than 24-h earlier they were diagnosed with CAP and required admission. We assessed the different values of the first blood count performed on the patient as follows; total white blood cells (WBC), neutrophils, lymphocytes (LYM), basophils, eosinophils (EOS), red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, red blood cell distribution width (RDW), platelets (PLT), mean platelet volume, and platelet distribution width (PDW). The primary outcome measure was 30-day mortality and the secondary, admission to an intensive care unit (ICU). The predictive power of the variables was determined by statistical calculation. Results One hundred sixty HIV-infected patients with pneumonia were identified. The mean age was 42 (11) years, 99 (62%) were male, 79 (49%) had ART. The main route of HIV transmission was through parenteral administration of drugs. Streptococcus pneumonia was the most frequently identified etiologic agent of CAP The univariate analysis showed that the values of PLT (p < 0.009), EOS (p < 0.033), RDW (p < 0.033) and PDW (p < 0.09) were predictor of mortality, but after the logistic regression analysis, no variable was shown as an independent predictor of mortality. On the other hand, higher RDW (OR = 1.2, 95% CI 1.1-1.4, p = 0.013) and a lower number of LYM (OR 2.2, 95% CI 1.1-2.2; p = 0.035) were revealed as independent predictors of admission to ICU. Conclusion Red blood cell distribution and lymphocytes were the most useful predictors of disease severity identifying HIV infected patients with CAP who required ICU admission. Electronic supplementary material The online version of this article (10.1186/s12879-018-3090-0) contains supplementary material, which is available to authorized users

Detection of human cytomegalovirus in bronchoalveolar lavage of intensive care unit patients

The seroprevalence of human cytomegalovirus (CMV) is very high worldwide [1, 2] and the spectrum of disease caused by it ranges from an asymptomatic state to a mononucleosis-like syndrome to severe diseases such as pneumonia, retinitis or gastrointestinal infection. The most severe disease occurs in congenital infection and in immunosuppressed patients, in whom the virus acts as an opportunistic pathogen. However, the role of CMV in other populations is less clear and is controversial [3]. Some studies in critical patients describe a relationship between CMV and increased mortality rates, longer length of stay and prolonged need for mechanical ventilation [3-5]. The incidence of active CMV infection depends on the diagnostic method used. Several epidemiological studies and systematic reviews have assessed the incidence of CMV infection in mechanically ventilated, critically ill patients, finding values ranging from 0-36% [5-7]. In this study, we aimed to assess the incidence, clinical characteristics, risk factors and outcomes for intensive care unit (ICU) patients with CMV detection by bronchoalveolar lavage (BAL)

Lack of detection of Middle East respiratory syndrome coronavirus in mild and severe respiratory infections in Catalonia, northeastern Spain

Surveillance of Middle East respiratory syndrome coronavirus (MERS-CoV) was conducted to explore the possible introduction and circulation of this novel virus in Catalonia, northeastern Spain. Five hundred and sixty-three samples from mild and severe respiratory infections collected between January 2012 and April 2013 were screened using real-time RT-PCR. All samples were negative, suggesting that MERS-CoV is not circulating silently in Catalonia

Toxicidad de extractos vegetales para el control de Trialeurodes vaporariorum W.(Homoptera: Aleyrodidae) en laboratorio y en cultivo de tomate en invernadero.

The constant search for natural insecticides in the form of extracts from many plants has received attention, and many of these extracts have been evaluated for their effectiveness as insecticides. To determine the toxic effect of six plant species Arundo donax L. (Poaceae), Brassica campestris L. (Brassicaceae), Cynodon dactylon L. (Poaceae), Hura polyandra Baill. (Euphorbiaceae), Phytollacca icosandra L. (Phytolaccaceae) and Sida acuta Burn. (Malvaceae) on Trialeurodes vaporariorum W. (Homoptera: Aleyrodidae) (adult whitefly), we evaluated the mortality rate and the lethal concentration (LC50) of the methanolic and aqueous extracts under laboratory and greenhouse conditions in a culture of Lycopersicum esculentum Mill. (Solanaceae). Analysis of Variance ANOVA and a test of comparison of means (Tukey, a = 0.05) showed a tendency of the methanolic extract in the six species towards a higher mortality rate and LC50 compared to that of the aqueous extract, both under greenhouse and laboratory conditions. The methanolic and aqueous extracts of A. donax and P. icosandra showed a higher toxicity under laboratory conditions (39.5 y 40.5%, respectively) than under greenhouse conditions (23.3 and 26.3%, respectively). The Treatments did not interfere with the tomato yield; so we are able to confirm the effectiveness of A. donax and P. icosandra extracts in the control of T. vaporariorum, which represents an ecological alternative for pest control in open field crops.La investigación de insecticidas naturales en forma de extractos de plantas ha recibido constante atención y varios de estos extractos han sido evaluados por su efectividad como insecticidas. Para determinar el efecto tóxico de seis especies de plantas Arundo donax L. (Poaceae), Brassica campestris L. (Brassicaceae), Cynodon dactylon L. (Poaceae), Hura polyandra Baill. (Euphorbiaceae), Phytolacca icosandra L. (Phytolaccaceae) y Sida acuta Burn. (Malvaceae) sobre Trialeurodes vaporariorum W. (Homoptera: Aleyrodidae) (mosca blanca en estadio adulto), evaluamos el grado de mortalidad y la dosis letal (CL50) de los extractos metanólico y acuoso en un experimento bajo condiciones de laboratorio e invernadero en un cultivo de Lycopersicum esculentum Mili. (Solanaceae). El análisis de varianza y la prueba de comparación de medias (Tukey, a = 0.05) mostraron una tendencia del extracto metanólico de seis especies hacia un mayor grado de mortalidad y de CL50 comparado con esos parámetros en el extracto acuoso bajo condiciones de laboratorio e Invernadero. Los extractos metanólico y acuoso de A. donax y P. icosandra mostraron la más alta toxicidad bajo condiciones de laboratorio (39.5 y 40.5%, respectivamente) e invernadero (23.3 y 26.3%, respectivamente). Los tratamientos no interfirieron con la producción de tomate, por lo que se puede confirmar la eficacia del uso de los extractos A. donax y P. icosandra para el control de T. vaporariorum como una alternativa para el control de la plaga en un cultivo a campo abierto sin contaminar el medio ambiente

Epidemiological and clinical characteristics of children hospitalized due to influenza A and B in the south of Europe, 2010-2016

Influenza produces annual epidemics that affect 5-15% of the world population. Complications and hospitalizations are more frequent in childhood. This study describes and analyses the epidemiological and clinical characteristics of children hospitalized due to confirmed influenza in influenza surveillance sentinel hospitals in Catalonia. Retrospective descriptive study conducted in six influenza seasons (2010-2011 to 2015-2016) in persons aged 0-17 years diagnosed with laboratory-confirmed influenza requiring hospitalization. 291 cases were notified to the health authorities: 79.4% were due to the influenza A virus and 20.6% to the B virus. The most common subtype was H1N1 with 57.6% of cases: 52.6% were male, 56.7% were aged <2 years, and 24.4% were aged <1 year. 62.2% of cases had pneumonia, 26.8% acute respiratory distress syndrome and 11.7% bacterial pneumonia. 5.8% of cases were vaccinated and 21.3% required intensive care unit admission, of whom 54.8% were aged <2 years. There were 3 deaths, all with influenza A infection. Influenza A cases were younger than influenza B cases (OR 3.22; 95% CI: 1.73-6.00). Conclusion: Children aged <2 years are especially vulnerable to the A H1N1 virus, including those without pre-existing chronic disease. These results are relevant for the planning of vaccination programs to improve maternal and child health