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Nucleocapsid antibody assays can be used to estimate SARS-CoV-2 infection prevalence in regions implementing spike-based COVID-19 vaccines. However, poor sensitivity of nucleocapsid antibody assays in detecting infection after vaccination has been reported. We derived a lower cutoff for identifying previous infections in a large blood donor cohort (N = 142,599) by using the Ortho VITROS Anti-SARS-CoV-2 Total-N Antibody assay, improving sensitivity while maintaining specificity >98%. We validated sensitivity in samples donated after self-reported swab-confirmed infections diagnoses. Sensitivity for first infections in unvaccinated donors was 98.1% (95% CI 98.0-98.2) and for infection after vaccination was 95.6% (95% CI 95.6-95.7) based on the standard cutoff. Regression analysis showed sensitivity was reduced in the Delta compared with Omicron period, in older donors, in asymptomatic infections,

To support the ongoing management of viral respiratory diseases while transitioning out of the acute phase of the COVID-19 pandemic, many countries are moving toward an integrated model of surveillance for SARS-CoV-2, influenza virus, and other respiratory pathogens. Although many surveillance approaches catalyzed by the COVID-19 pandemic provide novel epidemiologic insight, continuing them as implemented during the pandemic is unlikely to be feasible for nonemergency surveillance, and many have already been scaled back. Furthermore, given anticipated cocirculation of SARS-CoV-2 and influenza virus, surveillance activities in place before the pandemic require review and adjustment to ensure their ongoing value for public health. In this report, we highlight key challenges for the development of integrated models of surveillance. We discuss the relative strengths and limitations of different surveillance practices and studies as well as their contribution to epidemiologic assessment, forecasting, and public health decision-making.

Background: Immunosuppressive therapies are associated with a risk of infections. Nevertheless, their incidence in this population remains unclear. This study aims to determine the incidence of serious respiratory tract infections (SRI) in a population exposed to immunosuppressive therapies. Methods: Data from a representative sample of the French healthcare claims from 01/01/2014 to 12/31/2019 were analyzed. Exposure to immunosuppressive therapy was defined by the dispensation of drugs through community pharmacies or in hospitals. SRI diagnosis was based on ICD-10 codes from hospitalization records. A cohort analysis was performed to estimate standardized SRI incidence rates. A nested case-control analysis within this cohort was used to study the characteristics associated with SRI. Results: We identified 24,122 individuals exposed to immunosuppressive therapies, among which 1,559 developed SRI, resulting in a standardized incidence rate of 1,398 per 100,000 person-years. In this population, the risk of SRI was associated with a history of cancer (OR 2.68, 95% Confidence Intervals (CI) 2.24–3.21; p < 0.001), chronic respiratory disease (2.62, 95%CI 2.17–3.16; p < 0.001), end-stage renal failure (2.38, 95%CI 1.37–4.13; p = 0.003), neurodegenerative diseases (1.52, 95%CI 1.07–2.17; p = 0.026), diabetes (1.44, 95%CI 1.14–1.82; p < 0.001), psychiatric diseases (1.27, 95%CI 1.06–1.52; p < 0.001), and cardiovascular diseases (1.26, 95%CI 1.04–1.52; p = 0.002). Compared to corticosteroids alone, the risk of SRI was lower in individuals treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) only (0.44, 95%CI 0.25–0.78; p < 0.001). Conclusion: In the population exposed to immunosuppressive therapies, a history of chronic disease is associated with an increased risk of SRI. This risk is lower in those receiving csDMARD alone than corticosteroids alone. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions Clinical Trial Registration We conducted a multicentre, randomized phase 3 trial in China to evaluate the efficacy and safety of cofrogliptin (HSK7653), a novel long‐acting dipeptidyl peptidase‐4 inhibitor, in patients with drug‐naïve type 2 diabetes (T2D).Patients with inadequately controlled T2D were randomly assigned (1:1:1) to cofrogliptin 10 mg, cofrogliptin 25 mg or placebo, taken orally once every 2 weeks for a 24‐week double‐blind period. Eligible patients then received cofrogliptin 25 mg in a 28‐week open‐label extension. The primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline to week 24.In total, 475 patients (median age: 54.0 years) were randomized and received at least one dose of cofrogliptin 10 mg (n = 158), cofrogliptin 25 mg (n = 158) or placebo (n = 159); 401 patients entered the open‐label extension. At week 24, the least‐squares (LS) mean difference (95% confidence interval [CI]) in HbA1c versus placebo was −0.63% (−0.81, −0.46) with cofrogliptin 10 mg and −0.59% (−0.77, −0.42) with cofrogliptin 25 mg (both p < 0.0001). The LS mean (standard error) change in HbA1c from baseline was maintained at the end of the study in patients given open‐label cofrogliptin 25 mg for an additional 28 weeks: cofrogliptin 10 mg: −0.86% (0.07); cofrogliptin 25 mg: −0.74% (0.07); placebo: −0.89% (0.07). Over the entire study, common adverse events were hyperuricaemia, hyperlipidaemia, hypertriglyceridaemia, increased lipase, upper respiratory tract infection and urinary tract infection. Hypoglycaemic events did not significantly differ between groups.Cofrogliptin provided glycaemic control over 52 weeks and was generally well tolerated in patients with T2D.Registered on Clinicaltrials.gov with the registration number NCT04556851 (https://clinicaltrials.gov/study/NCT04556851). [ABSTRACT FROM AUTHOR]

Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous adverse reactions to medications characterized by keratinocyte necrosis leading to loss of protective barrier function and increased susceptibility to infection. Infection is a major cause of morbidity, and septicemia is the leading cause of mortality in this population. This systematic review and meta‐analysis aimed to determine infectious complications' prevalence and risk factors in adults with SJS and TEN. This review was registered with the International Platform of Registered Systematic Review and Meta‐Analysis Protocols (INPLASY) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) reporting guidelines. Thirty‐six articles describing results from 1446 cases were included. Skin infection was the most commonly diagnosed infection. The pooled prevalence of sepsis, respiratory tract infection, skin infection, and urinary tract infection was 27.3%, 21.5%, 37.5%, and 21.8%, respectively. Staphylococcus aureus was the most commonly identified organism. The overall quality of the studies was suboptimal, and the level of heterogeneity was high. The skin, bloodstream, respiratory, and urinary tracts are most commonly infected in the course of adult SJS and TEN. During hospitalization, clinicians should closely monitor and promptly investigate for these as well as several other infectious complications. More research is needed, with greater attention to the risk factors and causative organisms that cause these infections. [ABSTRACT FROM AUTHOR]

Respiratory pathogen infections are seasonally prevalent and are likely to cause co-infections or serial infections during peak periods of infection. Since they often cause similar symptoms, simultaneous and on-site detection of respiratory pathogens is essential for accurate diagnosis and efficient treatment of these infectious diseases. However, molecular diagnostic techniques for multiple pathogens in this field are lacking. Herein, we developed a microfluidic LAMP and real-time fluorescence assay for rapid detection of multiple respiratory pathogens using a ten-channel microfluidic chip with pathogen primers pre-embedded in the chip reaction well. The microfluidic chip provided a closed reaction environment, effectively preventing aerosol contamination and improving the accuracy of the detection results. Its corresponding detection instrument could automatically collect and display the fluorescence curve in real time, which was more conducive to the interpretation of results. The results showed that the developed method could specifically recognize the nucleic acid of influenza A(H1N1), Mycoplasma pneumoniae, respiratory syncytial virus type A, and SARS-CoV-2 with low detection limits of 104 copies per mL or 103 copies per mL. The test results on clinical samples demonstrated that the developed method has high sensitivity (92.00%) and high specificity (100.00%) and even has the capability to differentiate mixed-infection samples. With simple operation and high detection efficiency, the present portable and simultaneous detection assay could significantly improve the efficiency of on-site detection of respiratory infectious diseases and promote the accurate treatment, efficient prevention and control of the diseases. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside the hospital or other healthcare settings, typically affecting previously healthy individuals. This intersociety consensus aims to provide evidence-based recommendations for the antibiotic treatment of mild to moderate CAP in previously healthy children in Italy. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, with a date restriction from 2012 to April 2024, but without language limitations. The review included studies conducted in high-income countries on antibiotic therapy in children over 3 months of age diagnosed with mild-moderate CAP. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. Amoxicillin is the first-line treatment if the child is at least immunized against Haemophilus influenzae type b (low/very low quality of evidence, strong recommendations), while amoxicillin-clavulanate or second- or third-generation cephalosporins should be prescribed for those unimmunized or with incomplete immunization coverage for both H. influenzae type b and Streptococcus pneumoniae (low/very low quality of evidence, strong recommendations). Macrolides should be considered in addition to amoxicillin in children over 5 years old, if symptoms persist and the clinical condition remains good after 48 h of therapy (low/very low quality of evidence, strong recommendations). The dosage of amoxicillin is 90 mg/kg/day divided in three doses, although two doses could be considered to improve compliance (moderate quality of evidence, weak recommendations). A five-day duration of therapy is recommended, with clinical monitoring and re-assessment approximately 72 h after the start of antibiotic treatment to evaluate symptom resolution (moderate quality of evidence, strong recommendations). To improve the management of CAP in pediatric patients, we have developed this consensus based on a thorough review of the best available evidence and extensive discussions with an expert panel. However, further efforts are needed. Future research should focus on enhancing diagnostic accuracy, optimizing antibiotic utilization, comparing the efficacy of different antibiotic regimens, and determining the optimal dosage and duration of treatment in different setting. [ABSTRACT FROM AUTHOR]

Background: Post-streptococcal myalgia and myositis are very rare complications of streptococcal infections with group A β-haemolytic streptococci. Data on this condition are scarce and even less is known about findings in clinical imaging. Until today, there are no descriptions of ultrasonographic changes in this condition. Case presentation: We present a case of a 31-year-old female patient with immobilizing myalgia of the left outer thigh following a streptococcal upper respiratory tract infection, accompanied with erythemata nodosa on both shins. Laboratory results indicated post-streptococcal myositis since Creatine kinase, Lactate dehydrogenase and Antistreptolysin antibodies were significantly elevated. An ultrasound of the affected vastus medialis of the left quadriceps femoris muscle was performed, which showed a focal increase in muscle echogenicity with loss of architecture and hypervascularisation in Power Doppler Mode. The diagnosis of focal myositis was confirmed with magnetic resonance imaging. The patient's symptoms as well as the ultrasonographic changes fully resolved under therapy with Ibuprofen and intravenous Ampicillin/Sulbactam. Conclusions: This is the first description of ultrasound findings in this rare condition. We conclude that muscular ultrasound is helpful to identify myositis in post-streptococcal myalgia and myositis. [ABSTRACT FROM AUTHOR]

Probe-based nucleic acid enrichment represents an effective route to enhance the detection capacity of next-generation sequencing (NGS) in a set of clinically diverse and relevant microbial species. In this study, we assessed the effect of the enrichment-based sequencing on identifying respiratory infections using tiling RNA probes targeting 76 respiratory pathogens and sequenced using both Illumina and Oxford Nanopore platforms. Forty respiratory swab samples pre-tested for a panel of respiratory pathogens by qPCR were used to benchmark the sequencing data. We observed a general improvement in sensitivity after enrichment. The overall detection rate increased from 73 to 85% after probe capture detected by Illumina. Moreover, enrichment with probe sets boosted the frequency of unique pathogen reads by 34.6 and 37.8-fold for Illumina DNA and cDNA sequencing, respectively. This also resulted in significant improvements on genome coverage especially in viruses. Despite these advantages, we found that library pooling may cause reads mis-assignment, probably due to crosstalk issues arise from post-capture PCR and from pooled sequencing, thus increasing the risk of bleed-through signal. Taken together, an overall improvement in the breadth and depth of pathogen coverage is achieved using enrichment-based sequencing method. For future applications, automated library processing and pooling-free sequencing could enhance the precision and timeliness of probe enrichment-based clinical metagenomics. [ABSTRACT FROM AUTHOR]

Objectives: Many studies have confirmed that antibacterial agents can disrupt the human gut microbiota. In China, Tanreqing injection (TRQ) is a drug with antibacterial activity that is widely used in the treatment of respiratory infections. However, its specific influence on gut microbiota remains unclear. This study aimed to investigate the effect of TRQ on the gut microbiota of healthy volunteers. Methods: Twelve healthy adults received 20 ml of TRQ intravenously daily for 7 consecutive days. At six timepoints (Pre, on D1, D3, D5, D7 and follow-up visit) fecal samples were collected and analyzed using 16S rRNA gene sequencing. Results: Eleven people were included in the analysis finally. TRQ did not significantly alter gut microbiota diversity or richness (Shannon and Simpson and Chao1 index) in healthy people during the intervention. Gut microbial structure was stable (weighted and unweighted Unifrac). Using a machine learning method based on PLS-DA analysis, the separation trend on D7 at the genus level was found, returning to baseline two days after discontinuation. The abundance of major genus fluctuated on D7 compared with that prior to treatment, including an increase of unclassified_f_Enterobacteriaceae (13.0611%), a decrease of Bifidobacterium and Escherichia-Shigella (6.887%, 10.487%). Functional prediction analysis did not reveal any significant difference. Conclusions: Our study showed short-term use of TRQ at conventional doses may not cause perturbations to the gut microbiota in healthy adults. This finding provides some useful information for the safe use of TRQ in the treatment of respiratory infections. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusionRecurrent respiratory tract infections (RRTIs) in children represent a significant clinical challenge. Although some studies have identified potential risk factors, a comprehensive and systematic overview is lacking.This analysis is carried out to provide more advanced evidence to guide future prevention and health care.This study (PROSPERO: CRD42024576464) was conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published in English. Subgroup analysis, sensitivity analysis, and publication bias assessments were performed. Data analysis was conducted using Stata 17, and GRADE was employed to assess the quality of evidence. The risk factors identified in the positive results were discussed qualitatively.A total of 29 studies covering 639078 children were included. Some risk factors: asthma(OR = 3.08,2.06-4.62), breast feeding < 6 month(OR = 1.26,1.04-1.52), DCC: day care center(OR = 1.50,1.16-1.93), have siblings(OR = 1.26,1.00-1.59), ETS: Environmental tobacco smoke (OR = 1.13,1.00-1.27), snoring(OR = 1.49,1.16-1.93)got positive result.This analysis identifies several key risk factors for RRTIs in children, providing enhanced evidence for prevention and management strategies. In particular, asthma warrants closer attention, given its strong association with respiratory infections in pediatrics. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a pathogen associated with severe respiratory infections. The ability of S. aureus to internalize into lung epithelial cells complicates the treatment of respiratory infections caused by this bacterium. In the intracellular environment, S. aureus can avoid elimination by the immune system and the action of circulating antibiotics. Consequently, interfering with S. aureus internalization may represent a promising adjunctive therapeutic strategy to enhance the efficacy of conventional treatments. Here, we investigated the host-pathogen molecular interactions involved in S. aureus internalization into human lung epithelial cells. Lipid raft-mediated endocytosis was identified as the main entry mechanism. Thus, bacterial internalization was significantly reduced after the disruption of lipid rafts with methyl-β-cyclodextrin. Confocal microscopy confirmed the colocalization of S. aureus with lipid raft markers such as ganglioside GM1 and caveolin-1. Adhesion of S. aureus to α5β1 integrin on lung epithelial cells via fibronectin-binding proteins (FnBPs) was a prerequisite for bacterial internalization. A mutant S. aureus strain deficient in the expression of alpha-hemolysin (Hla) was significantly impaired in its capacity to enter lung epithelial cells despite retaining its capacity to adhere. This suggests a direct involvement of Hla in the bacterial internalization process. Among the receptors for Hla located in lipid rafts, caveolin-1 was essential for S. aureus internalization, whereas ADAM10 was dispensable for this process. In conclusion, this study supports a significant role of lipid rafts in S. aureus internalization into human lung epithelial cells and highlights the interaction between bacterial Hla and host caveolin-1 as crucial for the internalization process. [ABSTRACT FROM AUTHOR]

Background Comparative data are limited on the transmission of respiratory infections positive and negative for SARS-CoV-2 in households with children. Methods In June to August 2020, we recruited 700 participants (175 households, 376 children, 324 adults) to be prospectively followed for all respiratory tract infections. Follow-up lasted from recruitment until April 2022. Daily symptoms were monitored by weekly electronic questionnaires. SARS-CoV-2 polymerase chain reaction testing from nasopharyngeal specimens was performed for symptomatic participants and twice (1-week interval) for the household members of positive participants. Clinical features and secondary attack rates (SARs) based on the onset of symptoms were compared between respiratory infections that were SARS-CoV-2 positive and negative. Results Most SARS-CoV-2 infections (90%) occurred from January to April 2022 when Omicron BA.1 and BA.2 were the dominant variants. SARS-CoV-2–positive infections were transmitted more often than SARS-CoV-2–negative infections (SAR, 41% vs 24%; P <.001). SARS-CoV-2 transmission was similar for child and adult index cases (SAR, 40% vs 43%; P =.47), but the transmission of SARS-CoV-2–negative infections was higher for child index cases (SAR, 27% vs 18%; P <.001). Conclusions Our findings demonstrate that SARS-CoV-2 Omicron viruses spread more effectively within households as compared with other respiratory infections. [ABSTRACT FROM AUTHOR]

Enterovirus D68 (EV-D68) infections are associated with severe respiratory disease and acute flaccid myelitis (AFM). The European Non-Polio Enterovirus Network (ENPEN) aimed to investigate the epidemiological and genetic characteristics of EV-D68 infections and its clinical impact during the fall-winter season of 2021–2022. From 19 European countries, 58 institutes reported 10 481 (6.8%) EV-positive samples of which 1004 (9.6%) were identified as EV-D68 (including 852 respiratory samples). Clinical data were reported for 969 cases; 78.9% of infections were reported in children (0–5 years); and 37.9% of cases were hospitalized. Acute respiratory distress was commonly noted (93.1%) followed by fever (49.4%). Neurological problems were observed in 6.4% of cases including 6 diagnosed with AFM. Phylodynamic/Nextstrain and phylogenetic analyses based on 694 sequences showed the emergence of 2 novel B3-derived lineages, with no regional clustering. In conclusion, we describe a large-scale European EV-D68 upsurge with severe clinical impact and the emergence of B3-derived lineages. [ABSTRACT FROM AUTHOR]

Adverse outcomes of viral respiratory tract infections (RTIs) have been reported in recipients of allogeneic hematopoietic cell transplantation. Using a laboratory-developed multiparameter polymerase chain reaction in a consecutive series of 242 patients, we found the highest incidence of viral RTI in the preengraftment phase. The occurrence of multiple episodes of viral RTI or viral pneumonia was significantly associated with a higher hazard of nonrelapse mortality in the first year after transplantation. We observed a 90-day mortality of 19.7% after viral RTI, which was significantly different between patient groups stratified according to the immunodeficiency scoring index. [ABSTRACT FROM AUTHOR]

Background Unlike influenza, information on the burden of human metapneumovirus (HMPV) as a cause of hospitalizations in adults with acute respiratory illness (ARI) is limited. Methods We compared the population-based incidence, seasonality, and clinical characteristics of these 2 viral infections among adults aged ≥20 years with ARI hospitalizations in Auckland, New Zealand, during 2012–2015 through the Southern Hemisphere Influenza Vaccine Effectiveness Research and Surveillance (SHIVERS) project. Results Of the 14 139 ARI hospitalizations, 276 of 6484 (4.3%) tested positive for HMPV and 1342 of 7027 (19.1%) tested positive for influenza. Crude rates of 9.8 (95% confidence interval [CI], 8.7–11.0) HMPV-associated and 47.6 (95% CI, 45.1–50.1) influenza-associated ARI hospitalizations were estimated for every 100 000 adult residents annually. The highest rates for both viruses were in those aged ≥80 years, of Māori or Pacific ethnicity, or living in low socioeconomic status (SES) areas. HMPV infections were more common than influenza in those with chronic medical conditions. Conclusions Although HMPV infections accounted for fewer hospitalizations than influenza in adults aged ≥20 years, HMPV-associated ARI hospitalization rates were higher than influenza in older adults, Māori and Pacific people, and those of low SES. This highlights a need for vaccine/antiviral development. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV), along with other prominent respiratory RNA viruses such as influenza and SARS-CoV-2, significantly contributes to the global incidence of respiratory tract infections. These pathogens induce the production of reactive oxygen species (ROS), which play a crucial role in the onset and progression of respiratory diseases. However, the mechanisms by which viral RNA manages ROS-induced base oxidation remain poorly understood. Here, we reveal that 8-oxo-7,8-dihydroguanine (8-oxoGua) is not merely an incidental byproduct of ROS activity but serves as a strategic adaptation of RSV RNA to maintain genetic fidelity by hijacking the 8-oxoguanine DNA glycosylase 1 (OGG1). Through RNA immunoprecipitation and next-generation sequencing, we discovered that OGG1 binding sites are predominantly found in the RSV antigenome, especially within guanine-rich sequences. Further investigation revealed that viral ribonucleoprotein complexes specifically exploit OGG1. Importantly, inhibiting OGG1's ability to recognize 8-oxoGua significantly decreases RSV progeny production. Our results underscore the viral replication machinery's adaptation to oxidative challenges, suggesting that inhibiting OGG1's reading function could be a novel strategy for antiviral intervention. Author summary: Respiratory tract infections caused by RSV present a significant public health concern, especially affecting infants and the elderly. Effective antiviral strategies are urgently needed against this non-segmented, negative-sense RNA virus of the Pneumoviridae family. Our research reveals how RSV maintains replication fitness despite oxidative damage, a common exacerbator of respiratory conditions. We have identified a mechanism where RSV preserves its genome integrity under oxidative stress using the DNA repair enzyme OGG1. This enzyme ensures that the viral RNA accurately pairs 8-oxoGua with cytosine, crucial for maintaining the fidelity of the viral genome. Targeting the interplay between OGG1 and RSV RNA offers a promising approach for developing novel antiviral treatments, potentially countering the virus's evolutionary adaptations. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Subjects and Methods Results Conclusion To assess effects of the oral frailty index‐8 (OFI‐8) on the incidence of postoperative infection.This retrospective study included patients aged ≥ 65 years who underwent elective abdominal visceral surgery under general anaesthesia. Oral frailty was assessed using OFI‐8 (total score, 0–11), with higher scores indicating poorer oral health. The primary outcome measure was incidence of postoperative infection. The association between incidence of postoperative infection and OFI‐8 score was evaluated using multiple logistic regression analysis adjusted for clinically relevant preoperative and intraoperative covariates.Data of 791 patients (mean age, 74 years; mean OFI‐8 score, 3.4) were analysed. The OFI‐8 score had a linear association (P for nonlinear effect on postoperative infection = 0.43) with a composite postoperative infection at a rate of 14.2% (95% confidence interval: 11.8–16.7). The adjusted odds ratio of the OFI‐8 score for the primary outcome was 1.10 (95% confidence interval: 1.00–1.21), indicating that patients with higher OFI‐8 scores tended to have postoperative infections.This study's findings suggest that patients with higher OFI‐8 scores were more likely to develop postoperative infection after undergoing elective abdominal visceral surgery. [ABSTRACT FROM AUTHOR]

Background: Integrin α5β1 plays a crucial role in the invasion of nonphagocytic cells by Staphylococcus aureus (S. aureus), thereby facilitating infection development. Lipid nanoparticles (LNPs) serve as an effective vehicle for delivering small interfering ribonucleic acids (siRNA) that represent a method to knockdown integrin α5β1 in the lungs through nebulization, thereby potentially mitigating the severity of S. aureus pneumonia. The aim of this study was to harness LNP-mediated targeting to precisely knockdown integrin α5β1, thus effectively addressing S. aureus-induced pneumonia. Methods: C57 mice (8 week-old females) infected with S. aureus via an intratracheal nebulizing device were utilized for the experiments. The LNPs were synthesized via microfluidic mixing and characterized by their size, polydispersity index, and encapsulation efficiency. Continuous intratracheal nebulization was employed for consistent siRNA administration, with the pulmonary function metrics affirming biosafety. The therapeutic efficacy of LNP-encapsulated siRNAs against pneumonia was assessed through western blotting, bacterial count measurement, quantitative polymerase chain reaction, and histological analyses. Results: LNPs, which have an onion-like structure, retained integrity post-nebulization, ensuring prolonged siRNA stability and in vivo safety. Intratracheal nebulization delivery markedly alleviated the severity of S. aureus-induced pneumonia, as indicated by reduced bacterial load and bolstered immune response, thereby localizing the infection to the lungs and averting systemic dissemination. Conclusions: Intratracheal nebulization of LNP-encapsulated siRNAs targeting integrin α5β1 significantly diminished the S. aureus-mediated cellular invasion and disease progression in the lungs, presenting a viable therapeutic approach for respiratory infections. [ABSTRACT FROM AUTHOR]

Background: Warfarin and Direct Oral Anticoagulant (DOAC) users may have more frequent antibiotic prescriptions than non-users. The aim of this study was to estimate rates of common and resistant infections, and antibiotic prescribing amongst warfarin and DOAC users versus non-users. Methods: This matched retrospective cohort study used data from patients registered with General practices in England contributing to the Clinical Practice Research Datalink GOLD. We included 61,750 adults who initiated warfarin or a DOAC between 1st January 2011 and 31st December 2019, matched 1:1 to non-users. We estimated Incident Rate Ratios (IRR) and 95% Confidence Intervals for three common infections and all-cause antibiotic prescribing. We estimated hazard ratios (HRs) and 95% CIs for the risk of methicillin resistance Staphylococcus aureus (MRSA), other antibiotic-resistant organisms, or Clostridium difficile. We assessed the extent to which any of the effect of warfarin and DOAC use on antibiotic resistant infections or Clostridium difficile was mediated by antibiotic prescribing patterns. Results: 37,143 warfarin users and 24,607 DOAC users were matched 1:1 to non-users. Warfarin and DOAC users had greater relative consultation rates for respiratory, urinary, and skin infections. All-cause antibiotic prescribing was greater in warfarin and DOAC users (warfarin; adjusted IRR 1.47, 95% CI 1.45–1.50, DOAC; adjusted IRR 1.66, 95% CI 1.63–1.69). Largest effect sizes were observed for flucloxacillin (adjusted IRR 2.11, 95% CI 2.01–2.20), and erythromycin (adjusted IRR 2.32, 95% CI 2.00–2.70). Warfarin users had significantly higher risk of MRSA (adjusted HR 1.68, 95% CI 1.38–2.05) and hospital admission with antibiotic resistant infections (adjusted HR 1.91, 95% CI 1.11–3.30). DOAC users had significantly higher risk of MRSA (adjusted HR 1.57, 95% CI 1.20–2.06), hospital admission with antibiotic resistant infections (adjusted HR 2.13, 95% CI 1.61–2.82), and Clostridium difficile (adjusted HR 1.45, 95% CI 1.10–1.92). We found little evidence to suggest that the increased risks of studied outcomes were mediated by rates of antibiotic prescription. Conclusion: Warfarin and DOAC use was associated with greater rates of infection consultations, all-cause antibiotic prescribing, antibiotic resistant infections, and Clostridium difficile, but there was little evidence that antibiotic prescribing rates mediated risk of resistant infections or Clostridium difficile. [ABSTRACT FROM AUTHOR]

The study examines the link between early-life vitamin D exposure and childhood infection risk, particularly focusing on pneumonia in children up to age 3. Higher vitamin D levels at 6 months are associated with a reduced risk of pneumonia, suggesting a potential protective role of vitamin D against early airway infections. Previous research on antimicrobial peptides and airway immune profiles supports this finding. A systematic review by Martineau et al. in 2017 found evidence supporting the use of Vitamin D to prevent respiratory infections, while Brustad and Chawes discussed in a 2024 article the potential of Vitamin D in primary prevention of respiratory infections and asthma in early childhood. [Extracted from the article]

Introduction Methods Results Conclusion Cohen syndrome is a rare disease associated with neurodevelopmental disorders, especially intellectual disability (ID), neutropenia and recurrent infections are consistently reported in cases. Neutropenia is an important part of the syndrome, as well as ID. Homozygous variants in the VPS13B gene, located on chromosome 8q22 and containing 62 exons, have been found to cause Cohen syndrome. Cohen syndrome is commonly diagnosed when dysmorphological findings and developmental delay become more apparent. However, the identification of some findings with increasing age has caused the diagnosis of Cohen syndrome to be delayed.Cases diagnosed with ID were evaluated using whole‐exome sequencing/clinical exome sequencing method. Family segregation analysis was performed using Sanger sequencing. We presented the clinical and genetic findings of three cases diagnosed with Cohen syndrome and their parents in detail.In this study, we presented the occurrence of symptoms in different age groups, and the prognosis of three cases carrying the VPS13B gene variants, including three different variant types: missense, frameshift and nonsense. Although our cases had different variant types, they shared important similarities on the onset period and prognosis of the symptoms. All cases presented hypotonia, difficulties in swallowing, recurrent respiratory tract infections, neutropenia, delay in motor development, ID and hyperactivity. Our cases did not have a diagnosis of autism spectrum disorder. All cases had increased willingness to engage in social communication.We emphasize the importance of early‐onset recurrent infections and hypotonia for early diagnosis and preventive genetic counselling in Cohen syndrome. [ABSTRACT FROM AUTHOR]

Introcudtion Myocarditis is one of the leading causes of sudden cardiac deaths among athletes. One of the factors increasing the risk of this disease is engaging in sports training during an infection. Many athletes, regardless of their level of advancement, are not aware of the risks associated with training during an infection, and those who are aware often ignore them and continue training. Purpose Assessment of behaviors and awareness among runners in Poland regarding the risk of developing myocarditis as a result of training during respiratory tract infections. Material and method In December 2023, a voluntary and anonymous online survey was conducted among a group of 399 adult runners from Poland. The survey included 13 questions, consisting of 11 singlechoice questions and 2 multiple-choice questions. Results The percentage of individuals who do not associate training during an infection with an increased risk of myocarditis amounts to as much as 44.4% (n=177), while a staggering 86.7% (n=346) of respondents declare that they undertake training during respiratory infections. Conslusion After analyzing the survey, it's evident that while the Polish running community recognizes the risks of training during infections, many still exercise despite symptoms. Although most understand that intense training and early return to sports can harm health, awareness of myocarditis risks from exertion during infection is lacking. Despite protocols for post-illness return to sports, there's a need for campaigns to educate the running community on infectionrelated training risks. [ABSTRACT FROM AUTHOR]

Neutrophil subsets endowed with regulatory/suppressive properties are widely regarded as deleterious immune cells that can jeopardize antitumoral response and/or antimicrobial resistance. Here, we describe a sizeable fraction of neutrophils characterized by the expression of programmed death-ligand 1 (PD-L1) in biological fluids of humans and mice with severe viral respiratory infections (VRI). Biological and transcriptomic approaches indicated that VRI-driven PD-L1+ neutrophils are endowed with potent regulatory functions and reduced classical antimicrobial properties, as compared to their PD-L1-counterpart. VRI-induced regulatory PD-L1+ neutrophils were generated remotely in the bone marrow in an IFN dependent manner and were quickly mobilized into the inflamed lungs where they fulfilled their maturation. Neutrophil depletion and PD-L1 blockade during experimental VRI resulted in higher mortality, increased local inflammation, and reduced expression of resolving factors. These findings suggest that PD-L1+ neutrophils are important players in disease tolerance by mitigating local inflammation during severe VRI and that they may constitute relevant targets for future immune interventions. [ABSTRACT FROM AUTHOR]

Background: Respiratory tract infections are a common health problem. Cytokines/chemokines play a critical role in the regulation of the immune system. Their defective production may predispose to recurrent respiratory tract infections (RRIs), and an excessive immune response may lead to chronic inflammation and cause damage to the respiratory tract. Another biomarker of respiratory infections may be immunoglobulin—IgG4. Its meaning has still been little explored. We wanted to assess the suitability of the levels of biomarkers tested: interleukin (IL)‐17A, IL‐18, IL‐23, normal T cells expressed and secreted (RANTES), and induced protein (IP)‐10, as well as immunoglobilun G4 (IgG4) to predict recurrent infections. Methods: The study group (SG) included a total of 130 children (68 girls, 62 boys) between 3 and 17 years of age with RRI. The control group (CG) included 86 healthy children with no symptoms of inflammatory or allergic diseases (44 girls and 42 boys) of the same age. Blood samples were collected in fasting state and then serum samples were frozen and stored until biomarker assay. Results: Serum RANTES, IL‐18, IL‐23, and IgG4 concentration were higher in all children with recurrent infections vs. those in the CG (p < 0001). Serum levels of IL‐17A and IP‐10 were also significantly higher in the SG than in the CG, but only in the youngest children. Among the six serum markers, RANTES demonstrated the highest area under the receiver operating characteristic curve (area under curve) value (0.998, 95% confidence interval [CI]: 0.98–1.0, p < 0.001) for the diagnosis of RRIs, followed by IL‐23 (0.99, 95% CI 0.966–0,999, p < 0.001) and IL‐18 (0.957, 95% CI 0.921–0.980, p < 0.001). Conclusions: RANTES, IL‐23, and IL‐18 could be strong predictors of respiratory infections recurrence in children. [ABSTRACT FROM AUTHOR]

We characterized 15 H5N1 HPAI viruses from different small- and medium-scale poultry flocks across Bangladesh during 2018–2021 based on their complete genome sequences. The antigenic relatedness of H5N1 HPAI viruses from different timepoints was analysed. During 2020–2021, 42.11% of the flocks tested positive for at least one of the respiratory infections, with 15.79% showing influenza A virus, of which 8.77% tested positive for HPAIV H5N1. Co-infections with two to four pathogens were detected in 15.8% of flocks. Phylogeny and gene constellation analyses based on complete genome sequences of 15 HPAI viruses revealed the continuing circulation of H5 clade 2.3.2.1a genotype G2 viruses. In the HA protein of the study isolates, functionally meaningful mutations caused the loss of an N-linked glycosylation site (T156A), a modified antigenic site A (S141P), and a mutation in the receptor binding pocket (E193R/K). Consequently, antigenic analysis revealed a significant loss of cross-reactivity between viruses from different host species and periods. Most viruses displayed oseltamivir resistance markers at positions V96, I97, S227, and N275 (N1 numbering) of the NA protein. In addition, for the PB2, M1, and NS1 proteins, significant mutations were noticed that have been associated with polymerase activity and increased virulence for mammals in all study isolates. These results highlight the need for intensified genomic surveillance of HPAI circulating in poultry in Bangladesh and for establishing appropriate control measures to decrease the circulation of these viruses in poultry in the country. [ABSTRACT FROM AUTHOR]

Introduction: Adult-onset Still's disease is a rare systemic autoinflammatory disease. We present a case of a young man with a constellation of symptoms and myopericarditis as a complication of this disease. Case: A 36-year-old Hispanic man with no significant past medical history developed a quotidian fever pattern following an upper respiratory tract infection. He initially presented with chest pain concerning for myocardial infarction and underwent cardiac catheterization, which revealed non-obstructive coronary artery disease. He was found to have myopericarditis, significant neutrophilic leukocytosis, and hyperferritinemia. He improved on high-dose corticosteroids but developed steroid-induced psychosis, and 4 months from symptom onset, he finally received tocilizumab, which eventually induced remission without adverse reactions. Discussion: Adult-onset Still's disease should be considered in a patient with fevers of undetermined origin. Due to its multisystemic involvement, adult-onset Still's disease is often a diagnosis arrived at after an extensive cardiac, hematologic, malignant, and infectious workup. Imaging, laboratory testing, and bone marrow biopsy were necessary to rule out alternative etiologies of this patient's presentation. Steroids are the mainstay of treatment because they are easily affordable, although the high risk of adverse effects makes them less desirable. Interleukin-1 inhibitors (anakinra or canakinumab) and interleukin-6 inhibitor tocilizumab are the steroid-sparing biologic agents of choice but are cost-prohibitive. Conclusion: Adult-onset Still's disease should be considered in the differential diagnoses of fever of undetermined origin. Early identification and initiation of treatment are critical to faster recovery and prevention of progression to severe complications. Steroids remain the standard first-line therapy and should be followed by disease-modifying steroid sparing drugs. The social determinants of health may preclude their timely initiation and should alert providers of proactive ways to avoid further delays. [ABSTRACT FROM AUTHOR]

Moderate‐late preterm‐born infants experience more frequent and severe respiratory tract infections and wheezing compared to term‐born infants. Decreasing the risk on respiratory tract infections and wheezing in this group is vital to improve quality of life and reduce medical consumption during infancy, but also to reduce the risk on asthma and COPD later in life. Until now, moderate‐late preterm infants are underrepresented in research and mechanisms underlying their morbidity are largely unknown, although they represent 80% of all preterm‐born infants. In order to protect these infants effectively, it is essential to understand the role of the immune system in early life respiratory health and to identify strategies to optimize immune development and respiratory health. This review elaborates on risk factors and preventative measures concerning respiratory tract infections and wheezing in preterm‐born infants, exploring their impact on the immune system and microbiome. Factors discussed are early life antibiotic use, birth mode, feeding type and living environment. Further, differences in adaptive and innate immune maturation between term and preterm infants are discussed, as well as differences in local immune reactions in the lungs. Finally, preventative strategies are being explored, including microbiota transplantation, immune modulation (through pre‐, pro‐, syn‐ and postbiotics, bacterial lysates, vaccinations, and monoclonal antibodies) and antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Common cold coronaviruses (ccCoVs) and influenza virus are common infectious agents causing upper respiratory tract infections (RTIs). However, clinical symptoms, comorbidities, and health effects of ccCoV infection remain understudied. Methods: A retrospective study evaluated 3,935 outpatients with acute upper RTI at a tertiary teaching hospital. The presence of ccCoV and influenza virus was determined by multiplex molecular assay. The demographic, clinical symptoms, and health outcomes were compared between patients with ccCoV (n = 205) and influenza (n = 417) infections. Multivariable logistic regression was employed to evaluate predictors and health outcomes over a one-year follow-up. Results: Sore throat, nasal discharge, headache, and myalgia were more predominant in ccCoV infection; fever was common in influenza. Most patients reported moderate symptoms severity (49.8% ccCoV, 56.1% influenza). Subsequent primary care visits with symptoms of RTI within a year were comparable for both infections (27.3% ccCoV vs. 27.6% influenza). However, patients with influenza reported increased primary care visits for non-RTI episodes and all-cause hospital admission. Baseline comorbidities were associated with increased primary care visits with symptoms of RTI in either ccCoV (adjusted odds ratio [aOR] 2.5; 95% confidence interval [CI] 1.1–5.9; P = 0.034) or influenza (OR 1.9; 95% CI 1.1–3.1; P = 0.017) infections, due probably to the dysregulation of the host immune response following acute infections. In patients infected with influenza infection, dyslipidemia was a predictor for subsequent primary care visits with symptoms of RTI (unadjusted OR 1.8; 95% CI 1.0–3.0; P = 0.040). Conclusions: Both influenza and ccCoV infection pose significant disease burden, especially in patients with comorbidities. The management of comorbidities should be prioritized to mitigate poor health outcomes in infected individuals. [ABSTRACT FROM AUTHOR]

Mucopolysaccharidosis type II (MPS II) is a rare X-linked recessive inherited lysosomal storage disease. With pathogenic variants of the IDS gene, the activity of iduronate-2-sulfatase (IDS) is reduced or lost, causing the inability to degrade glycosaminoglycans (GAGs) in cells and influencing cell function, eventually resulting in multisystemic manifestations, such as a coarse face, dysostosis multiplex, recurrent respiratory tract infections, and hernias. Diagnosing MPS II requires a combination of clinical manifestations, imaging examinations, urinary GAGs screening, enzyme activity, and genetic testing. Currently, symptomatic treatment is the main therapeutic approach. Owing to economic and drug availability issues, only a minority of patients opt for enzyme replacement therapy or hematopoietic stem cell transplantation. The limited awareness of the disease, the lack of widespread detection technology, and uneven economic development contribute to the high rates of misdiagnosis and missed diagnosis in China. [ABSTRACT FROM AUTHOR]

Current global burden of respiratory tract infections (RTIs) has thrown new challenges for researchers to design and develop efficient and multifaceted face masks. Airborne pathogens are highly transmissible through droplet nuclei/aerosol (<5 μm) which can be significantly reduced by wearing masks. Currently available disposable surgical masks have disparate limitations in terms of surface wettability, microbial penetration, dermal infections due to anaerobic reactions beneath the surface, discomfort, and eruption of chronic obstructive pulmonary diseases (COPD). These mask surfaces get contaminated with airborne pathogens along with commensal bacterial strains. Generation of high temperature and humidity during repetitive breathing allow bacteria to penetrate from the masks to respiratory tract causing serious complications. Till date, functionalized face masks with different microbicidal agents including nanomaterials experience restricted leaching of antimicrobial agents, cytotoxic effects, short‐lived microbicidal effects, inflammatory responses, negative impact on ecosystem, etc. To address these limitations, here, we have attempted fabrication of mussel mimetic biopolymer (PDA) and its aminoglycoside‐nanoconjugate‐coated face masks. Formation of a uniform layer on the surface not only acted as a potential barrier for infectious pathogens but also inhibited their entry, deactivated the adhered bacteria, imparted non‐immunogenic response with no harmful effects on the wearer's skin owing to the biocompatible nature and pH compatibility of PDA and their conjugates. Amongst all, PDA‐kanamycin (PDA−K)‐coated masks exhibited excellent microbicidal activity with the least bacterial infiltration efficiency. [ABSTRACT FROM AUTHOR]

Background: Early targeted antibiotic therapy is crucial for improving the prognosis of immunocompromised patients with severe respiratory infections (SRIs) in the intensive care unit (ICU). Metagenomic next-generation sequencing (mNGS) has shown significant value in pathogen detection, but research on lower respiratory tract microorganisms remains limited. Methods: This study enrolled 234 patients with SRIs in the ICU, and individuals were categorized into immunocompromised and immunocompetent groups. We compared the diagnostic performance of mNGS using bronchoalveolar lavage fluid (BALF) with conventional microbiological tests (CMTs) and analyzed the value of mNGS in immunocompromised patients with SRIs in the ICU. Results: Among all patients, the pathogenic microorganism detection rate of mNGS was higher than that of CMTs (94.02% vs 66.67%, P < 0.05), both in the immunocompromised group (95.0% vs 58.75%, P < 0.05) and the immunocompetent group (93.51% vs 71.43%, P < 0.05). mNGS detected more pathogens than CMTs did (167 vs 51), identifying 116 organisms that were missed by CMTs. The proportion of antibiotic regimen adjustments based on mNGS results was significantly higher compared to CMTs in both the immunocompromised (70.00% vs 17.50%, P < 0.05) and immunocompetent groups (48.70% vs 15.58%, P < 0.05). In the immunocompromised group, patients who had their antibiotic treatment adjusted on mNGS results had improved prognosis, with significantly lower ICU mortality (8.93% vs 50%, P < 0.05) and 28-day mortality rates (30.36% vs 68.75%, P < 0.05) than CMTs. In the immunocompetent group, no statistically significant differences were observed in ICU mortality or 28-day mortality (20.00% vs 33.33%, P > 0.05; 42.67% vs 45.83%, P > 0.05). Conclusion: mNGS shows significant value in detecting pathogens in immunocompromised patients with SRIs in ICU. For immunocompromised patients who respond poorly to empirical treatment, mNGS can provide an etiological basis, helping adjust antibiotic regimens more precisely and thereby improving patient prognosis. [ABSTRACT FROM AUTHOR]

Background: Influenza is the most common vaccine-preventable infection among travelers, affecting approximately one percent of those travelling to subtropical and tropical destinations. Methods: We analysed demographic, travel-related and clinical information from travelers diagnosed with influenza at our travel clinic between January 2015 and March 2020 and influenza-negative controls. Results: We included 68 travelers diagnosed with influenza and 207 controls. In total, 22.1% of influenza patients (n = 15) were older than 60 years and/or had comorbidities for which annual influenza vaccination is recommended, but only one had received an influenza vaccine. Patients with respiratory and musculoskeletal symptoms who presented during the German influenza season had the highest risk proportion of positive tests (54%, n = 25/46). Overall, three (4.4%) influenza patients were hospitalised, two (2.9%) received antiviral treatment, and eight (11.8%) received antibiotic therapy. Conclusions: Influenza occurs throughout the year in international travelers and can cause significant morbidity. Travelers with febrile illness should be tested for influenza, especially if they have respiratory or musculoskeletal symptoms, present during the local influenza season, or have travelled to South-East Asia. Influenza vaccination coverage among international travelers needs to be improved among high-risk individuals. [ABSTRACT FROM AUTHOR]

Evolving evidence suggests that Janus Kinase Inhibitors (JAKi) may predispose to certain infections, including tuberculosis and human herpes viruses. This review aimed to compare the infection risk in patients on a systemic JAKi for a dermatologic indication to a placebo. A systematic review was carried out from inception to June 2023, using the EMBASE, Medline, SCOPUS, and Cochrane Library of Registered Trials databases. Eligible studies included placebo‐controlled randomized trials that investigated the incidence of infection in patients with a dermatologic indication. Primary outcomes included the most commonly reported infections pertaining to serious and opportunistic infections, upper respiratory tract infections, nasopharyngitis, herpes simplex, varicella zoster, tuberculosis, neutropenia, and lymphopenia. A meta‐analysis of incidence ratios was conducted to determine odds ratios (OR), with a 95% confidence interval (CI) analysis. The meta‐analysis found no increased risk of serious (OR: 0.92, 95% CI: 0.61–1.43, P = 0.74) or opportunistic infections (OR: 0.65, 95% CI: 0.32–1.31, P = 0.23). The incidence of varicella‐zoster infections was significantly higher in the JAKi cohort (OR: 1.72, 95% CI: 1.08–2.72, P = 0.022). From 25 studies, there was no overall increased risk of herpes simplex infections (OR: 1.43, 95% CI: 0.93–2.23, P = 0.102) to placebo; however, a significantly higher risk in those with atopic dermatitis to alopecia areata was demonstrated (OR: 1.73, 95% CI: 1.13–2.69, P = 0.013). The results of this analysis do not suggest an increased risk of serious and opportunistic infections in those on JAKi compared to placebo. However, they support an increased risk of varicella‐zoster infections and a higher risk of herpes simplex infections in those with atopic dermatitis to alopecia areata. The results of this report support these agents' short‐term safety but signal that vigilance should be practiced in patients at risk for serious or recurrent herpes virus infections. [ABSTRACT FROM AUTHOR]

Introduction: Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS). Methods: This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis. Results: Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21–8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis. Discussion: Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates. Trial registration: ClinicalTrials.gov identifier: NCT06069414. [ABSTRACT FROM AUTHOR]

Background: Respiratory Syncytial Virus (RSV) is an important pathogen causing acute respiratory illnesses in adults. RSV infection can lead to severe outcomes, including hospitalizations and even death. Despite the increased recognition of the burden in older adults, immediate post-discharge care needs among adults hospitalized with RSV are not well characterized and have not been compared to other serious medical conditions (such as influenza, acute myocardial infarction (MI), and stroke) for which there have been long-standing disease prevention efforts. Objectives: This study aims to describe the immediate post-discharge care needs among adults hospitalized with RSV in the United States and descriptively compare it to those hospitalized with influenza, acute MI, or stroke. Design: Retrospective observational cohort study. Patients: Adults aged ≥ 18 years, hospitalized with a primary diagnosis of RSV, influenza, acute MI, or stroke from January 01, 2016, to December 31, 2019, were identified from the Premier Healthcare Database using the International Classification of Diseases (ICD-10) codes. Main measures: Immediate post-discharge care was categorized into three different levels of care based on the discharge dispositions. Descriptive analyses were performed. Key results: In total, 3,629 RSV, 303,577 influenza, 388,682 acute MI, and 416,750 stroke hospitalizations were identified, the majority occurred among patients aged ≥ 65 years. Professional home care needs were the highest for RSV hospitalizations (19.1%), followed by influenza (17.7%), stroke (15.4%), and acute MI (9.8%). Additionally, institutional care needs immediately following discharge were similar for RSV, influenza, and acute MI hospitalizations (14.2%, 15.8%, and 14.1%, respectively). Conclusions: Immediate post-discharge care needs among adults hospitalized with RSV, especially in older adults, can be considerable and comparable to influenza and acute MI discharges. With recently approved RSV vaccines, efforts to increase vaccination in older adults are needed to prevent RSV and associated healthcare consequences. [ABSTRACT FROM AUTHOR]

This document is a compilation of references related to the outbreak of avian influenza, specifically the H5N1 strain, in different regions worldwide. It includes scientific articles, reports, and studies discussing the spread of the virus among wild birds, marine mammals, and other animals. The references also cover the impact of the virus on various species and ecosystems, as well as efforts to control and prevent its spread. Researchers and library patrons interested in studying the avian influenza outbreak and its effects on wildlife will find valuable information in these references. Additionally, the document includes references to topics such as marine mammal ecotoxicology, the conservation of Galápagos birds, the prevention and control of highly pathogenic avian influenza, and Ecuador's preparedness and response to the COVID-19 pandemic. [Extracted from the article]

Introduction: Pneumonia which is a form of acute lower respiratory tract infection, affects the lung parenchyma and destructs alveolar air space. Pneumonia continues to be a leading cause of morbidity and mortality in children. An institutional cross-sectional study was employed. Aim: The aim of this study specifically focused on dynamically monitoring the levels of specific biomarkers, including C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cell (s-TREM), Chitinase-3-like protein 1 (CHI3L1) and white blood cell (WBC) in the blood (serum) of children with pneumonia. Material and methods: The study involved 120 children diagnosed with pneumonia in Iraq, classified into different age groups. In total, 53 individuals with pneumonia infection were investigated. Biomarker levels including sTREM-1, CRP, CHI3L1, and WBC were analyzed to assess the severity of the disease. The data was collected from November 2023 to April 2024 and analyzed using SPSS software and Microsoft Excel 2019. Pearson's correlation was used to evaluate the relationship between biomarker levels and pneumonia severity. Results and discussion: The results indicated that pneumonia was more frequent in children of under 5 years old. Interestingly, sTREM-1 level was consistently higher than other biomarkers, while WBC counts were the lowest among all biomarkers in all ages and pneumonia cases of study children. These differences were statistically significant, meaning they are likely not random findings. Conclusions: sTREM-1 followed by CHI3L1 may be more useful tools for identifying pneumonia and assessing its severity in young children compared to traditional biomarkers like WBC and CRP. [ABSTRACT FROM AUTHOR]

A 25-year-old man presented with a rash, headache, confusion, and speech problems following an upper respiratory tract infection. He exhibited various neurological symptoms and cutaneous manifestations resembling erythema nodosum. After extensive testing, he was diagnosed with Neuro-Sweet syndrome, a rare condition characterized by febrile neutrophilic dermatosis and neurological manifestations. Treatment with systemic corticosteroids led to significant improvement in his symptoms, highlighting the importance of early diagnosis and appropriate management in such cases. [Extracted from the article]

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections (LRTIs) and hospital admissions in early childhood. Recent advancements in novel preventive therapies, including extended half‐life monoclonal antibodies and antenatal vaccination, have afforded new opportunities to significantly reduce the burden of this infection. Nirsevimab is a novel monoclonal antibody that provides sustained protection against RSV for at least 5 months among newborns and young children. It has received regulatory approval in numerous countries and is being implemented across various settings. Two pivotal Phase 3 trials (MELODY, HARMONIE) demonstrated significant reductions in RSV‐associated LRTI hospitalisations following nirsevimab administration, with treatment efficacy of 62.1% and 83.2%. Emerging real‐world data from early adopters of nirsevimab corroborates these findings. Studies from Spain, Luxembourg, France and the USA report effectiveness rates between 82% and 90% in preventing RSV‐associated hospitalisations among infants entering their first RSV season. Current implementation strategies for nirsevimab have primarily focused on seasonal administration for all infants, aligned to local RSV seasons, and often include catch‐up doses for those born before the season begins. Available cost‐effectiveness analyses indicate that while nirsevimab offers significant potential public health benefits, its adoption must carefully consider economic factors such as treatment costs, implementation strategies tailored to local viral epidemiology, and logistics for vaccine delivery. Overall, nirsevimab presents a promising opportunity to alleviate the burden of severe RSV infections in young children. However, ongoing surveillance and refinements in implementation strategies are crucial to optimise its impact and ensure sustainability across diverse health‐care settings. [ABSTRACT FROM AUTHOR]

Background Lower respiratory infections and invasive disease caused by Streptococcus pneumoniae serotype 3 remain major clinical challenges around the world, despite widespread availability of updated vaccines. Methods As part of CANWARD, antimicrobial susceptibility testing and serotyping were performed on all S. pneumoniae isolates from 2007 to 2021. A subset of 226/264 (85.6%) serotype 3 isolates were selected for WGS to determine sequence type (ST)/clonal cluster (CC) and correspondence of antimicrobial resistance determinants (erm , mefAE , tetM , cat , folA , folP) with resistance phenotype. Results Of the 3,039 S. pneumoniae isolates obtained from 2007 to 2021, 8.7% (n  = 264) were serotype 3, with 64.0% of respiratory origin and 36.0% from blood. Of 226 sequenced serotype 3 isolates, 184 (81.4%) were ST180 (GPSC12). The proportion of ST8561 (single locus variant of ST180) increased from 7.2% to 16.6% during the study period. An increasing proportion of serotype 3 isolates had phenotypic resistance (P  = 0.0007) and genetic resistance determinants (P  = 0.004), comparing 2017–21 to 2007–11, largely due to a recently expanded ST180 clade with cat , tetM and mef determinants. Conclusions S. pneumoniae serotype 3 from GPSC12 continues to dominate throughout Canada, with an increase in the proportion of ST8561. The proportion of serotype 3 isolates that are phenotypically resistant and with genetic resistance determinants is increasing over time, reflecting a global increase in GPSC12 genotypes with known resistance determinants. Phylogenomic characterization of isolates collected over time and from around the world may facilitate improved treatment and enhanced prevention strategies, including new vaccines with activity against S. pneumoniae serotype 3. [ABSTRACT FROM AUTHOR]

Pulmonary infections are an important consideration in the management of patients with rheumatological diseases, especially in those with associated lung disease. Underlying altered immune status and administration of immunomodulatory drugs are thought to be the primary drivers of increased susceptibility to infection. Multiple studies have suggested that rheumatic patients, especially those taking biologic agents such as tumor necrosis factor-alpha (TNF-a) inhibitors, are at an increased risk of infection. Clinicians can attenuate the risk of serious infections by ensuring appropriate vaccination and by screening patients carefully for opportunistic infections prior to initiating therapy with biologic agents. Any signs or symptoms of pulmonary infection should be taken seriously, and both common and uncommon pathogens must be considered in the differential diagnosis. The management of pulmonary infections in rheumatic patients can be challenging, sometimes requiring cessation of immunomodulatory therapy and consultation with infectious diseases specialists andshould be tailored to the individual patient. [ABSTRACT FROM AUTHOR]

The diagnosis of severe respiratory infections in intensive care remains an area of uncertainty and involves a complex balancing of risks and benefits. Due to the frequent colonisation of the lower respiratory tract in mechanically ventilated patients, there is an ever-present possibility of microbiological samples being contaminated by bystander organisms. This, coupled with the frequency of alveolar infiltrates arising from sterile insults, risks over-treatment and antimicrobial-associated harm. The use of bronchoscopic sampling to obtain protected lower respiratory samples has long been advocated to overcome this problem. The use of bronchoscopy further enables accurate cytological assessment of the alveolar space and direct inspection of the proximal airways for signs of fungal infection or alternative pathologies. With a growing range of molecular techniques, including those based on nucleic acid amplification and even alveolar visualisation and direct bacterial detection, the potential for bronchoscopy is increasing concomitantly. Despite this, there remain concerns regarding the safety of the technique and its benefits versus less invasive sampling techniques. These discussions are reflected in the lack of consensus among international guidelines on the topic. This review will consider the benefits and challenges of diagnostic bronchoscopy in the context of severe respiratory infection. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, there was increased interest in the issue of thrombotic complications of acute respiratory infections. Clinical reports and pathological studies have revealed that thrombus formation in COVID-19 may involve the venous and arterial vasculature. As thrombotic complications of infectious respiratory diseases are increasingly considered in the context of COVID-19, the fact that thrombosis in lung diseases of viral and bacterial etiology was described long before the pandemic is overlooked. Pre-pandemic studies show that bacterial and viral respiratory infections are associated with an increased risk of thrombotic complications such as myocardial infarction, ischemic stroke, pulmonary embolism, and other critical illnesses caused by arterial and venous thrombosis. This narrative review article aims to summarize the current evidence regarding thrombotic complications and their pathogenesis in acute lower respiratory tract infections. [ABSTRACT FROM AUTHOR]

Background: Identifying high-risk COVID-19 patients is critical for emergency department decision-making. Our study's primary objective was to identify new independent predictors of mortality and their predictive utility in combination with traditional pneumonia risk assessment scores and new risk scores for COVID-19 developed during the pandemic. Methods: A retrospective study was performed in two Italian University Hospitals. A multivariable logistic model was used to locate independent parameters associated with mortality. Results: Age, PaO2/FiO2, and SpO2/FiO2 ratios were found to be independent parameters associated with mortality. This study found that the Pneumonia Severity Index (PSI) was superior to many of the risk scores developed during the pandemic, for example, the International Severe Acute Respiratory Infection Consortium Coronavirus Clinical Characterisation Consortium (ISARIC 4C) (AUC 0.845 vs. 0.687, p < 0.001), and to many of the risk scores already in use, for example, the National Early Warning Score 2 (NEWS2) (AUC 0.845 vs. 0.589, p < 0.001). Furthermore, our study found that the Pneumonia Severity Index had a similar performance to other risk scores, such as CRB-65 (AUC 0.845 vs. 0.823, p = 0.294). Combining the PaO2/FiO2 or SpO2/FiO2 ratios with the risk scores analyzed improved the prognostic accuracy. Conclusions: Adding the SpO2/FiO2 ratio to the traditional, validated, and already internationally known pre-pandemic prognostic scores seems to be a valid and rapid alternative to the need for developing new prognostic scores. Future research should focus on integrating these markers into existing pneumonia scores to improve their prognostic accuracy. [ABSTRACT FROM AUTHOR]

Background: Lower respiratory tract infections (LRTIs) are a significant cause of primary care consultations. Differentiating between viral and bacterial infections is critical for effective treatment and to minimize unnecessary antibiotic use. This study investigates the impact of combining lung ultrasound (LUS) with capillary blood C-reactive protein (CRP) rapid testing on clinical decision-making for patients with LRTIs. Objectives: The primary objective is to assess how the integration of CRP testing and LUS influences antibiotic prescription decisions. The study aims to quantify the percentage change in antibiotic prescriptions before and after performing LUS, following history taking, clinical examination, and CRP testing. Methods: This analytical observational study will be conducted in six primary care centers within the Health Region of Lleida, Catalonia, serving a mixed urban and rural population of approximately 105,000 residents. The study will recruit 196 patients aged 18 and over, presenting with LRTI symptoms and not treated with antibiotics in the preceding 14 days. Participants will undergo CRP testing followed by LUS during their consultation. Statistical analyses, including linear regression, bivariate analysis, Pearson or Spearman correlation, and logistic regression, will be used to evaluate the impact of LUS on clinical decisions and its predictive value in diagnosing bacterial infections. Results and Conclusions: This study will provide insights into the role of LUS combined with CRP testing in improving diagnostic accuracy and guiding antibiotic prescription decisions in primary care. The findings aim to enhance treatment protocols for LRTIs, reducing unnecessary antibiotic use and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Influenza can lead to or coexist with severe bacterial pneumonia, with the potential to permanently damage lung tissue, refractory to conservative treatment in the post-COVID-19 period. It can lead to serious complications; therefore, annual vaccinations are recommended. This case series with a literature review pertains to two young female patients with an insignificant past medical history, who required emergency lobectomy due to bacterial complications after influenza infection. Urgent lobectomy proves to be a feasible therapeutic option for selected patients with pleural complications. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the urgent need for rapid and accurate diagnostic tools for upper respiratory tract infections (URTIs). Nucleic acid amplification tests (NAATs) have transformed URTI diagnostics by enabling the rapid detection of multiple pathogens simultaneously, thereby improving patient management and infection control. This study aimed to evaluate the diagnostic accuracy of the LabTurbo QuadAIO Common Flu Assay compared to that of the Xpert Xpress CoV-2/Flu/RSV Plus Assay for detecting SARS-CoV-2, Influenza A, Influenza B, and respiratory syncytial virus (RSV). Methods: A retrospective diagnostic accuracy study was conducted using nasopharyngeal samples from patients. Samples were tested using the LabTurbo QuadAIO Common Flu Assay and the comparator Xpert Xpress CoV-2/Flu/RSV Plus Assay. Positive and negative percent agreements (PPA and NPA) were calculated. Results: The LabTurbo Assay demonstrated a PPA of 100% and an NPA of 100% for SARS-CoV-2, Influenza A, and Influenza B, whereas it showed a PPA of 100% and an NPA of 98.3% for RSV. Conclusions: The LabTurbo QuadAIO Assay exhibited high diagnostic accuracy for detecting multiple respiratory pathogens, including SARS-CoV-2, Influenza A, Influenza B, and RSV. Despite the slight discrepancy in the NPA for RSV, the overall performance of the LabTurbo Assay supports its integration into routine diagnostic workflows to enhance patient management and infection control. [ABSTRACT FROM AUTHOR]