Search Results (120)

Background: During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. Objective: To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI. Methods: This retrospective analysis combined two national multicentre ICU registries in Spain, including 4197 adult patients requiring invasive mechanical ventilation for influenza A(H1N1) or COVID-19 between 2009 and 2021. Primary outcomes were ICU mortality and VAP incidence. Analyses were stratified by microbiologically confirmed bacterial COI. Propensity score matching, Cox regression, General Linear (GLM), and random forest models were applied. Results: Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, p = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, p = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, p < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, p = 0.03) compared to inappropriate EAT. Conclusions: EAT was not associated with a lower incidence of VAP or higher survival rates and could be harmful if administered incorrectly. These findings support a more targeted approach to antibiotic use, guided by microbiology, biomarkers and stewardship principles. Full article

Respiratory syncytial virus (RSV) continues as the major cause of acute lower respiratory tract infections in children around the world, and its substantial morbidity, particularly among infants and high-risk children, poses a significant burden on healthcare systems worldwide. RSV infections occur as a spectrum, ranging from mild upper respiratory symptoms to severe bronchiolitis and pneumonia, and the number of infections shows seasonal variations in different latitudes, as well as lasting impacts, reflecting the COVID-19 pandemic. The pathogenesis of the virus involves epithelial cell invasion and/or fusion to form syncytia, along with exaggerated immune-mediated responses. Disease severity is known to depend on viral load, strain variation, and host immune immaturity. Severe RSV infection during infancy is notably linked with long-term respiratory sequelae such as recurrent wheezing and asthma. Diagnosis is based on clinical suspicion and laboratory confirmation using rapid antigen testing or nucleic acid amplification tests, namely PCR. Non-pharmaceutical interventions, maternal vaccination, and prophylaxis with monoclonal antibodies, e.g., palivizumab and nirsevimab, a newly introduced long-acting agent, are efficient protective and preventive measures. Treatment is still, for the most part, supportive in nature and focuses on oxygen supplementation, hydration, and respiratory support for patients with more severe disease courses; however, the development of immunoprophylaxis and vaccine candidates shows promise for reducing the global burden of RSV. Full article

After the transition of coronavirus disease 2019 (COVID-19) from a pandemic to an endemic phase, data on respiratory viral infections remain limited. This study compared the clinical outcomes of SARS-CoV-2, influenza virus (INFV), and respiratory syncytial virus (RSV) infections and investigated how underlying medical conditions influence disease severity. During Omicron subvariant dominant periods, we conducted a multicenter, retrospective cohort study including laboratory-confirmed cases of SARS-CoV-2, INFV, and RSV infections in hospitalized patients aged ≥ 19 years. We compared demographic characteristics and clinical outcomes and analyzed the association between underlying comorbidities and severity of infection. A total of 1850 cases with SARS-CoV-2, 98 with INFV, and 63 with RSV infections were analyzed. Notable differences in the occurrence of fever, cough, sputum, and dyspnea were observed among patients with the three different viral infections. Pneumonia was diagnosed more frequently in patients with RSV infection (65.6%) compared to those with INFV infection (42.9%) and SARS-CoV-2 (34.4%) (p < 0.01). For patients with SARS-CoV-2 infection, the risk of pneumonia increased by 47% in the moderate-risk group and 37% in the high-risk group. Among hospitalized patients, pneumonia was more frequently identified in patients with RSV infection, with statistical significance. Furthermore, the presence of medical conditions significantly increased the risk of developing pneumonia. Full article

The global impact of the COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), persists in part due to the emergence of new variants. Understanding variant-specific infection dynamics and pathogenesis in murine models is crucial for identifying phenotypic changes and guiding the development of countermeasures. To address the limitations of earlier studies that investigated only a few variants or used small sample sizes, we evaluated clinical disease, infection kinetics, viral titers, cellular localization, and histopathologic changes in the lungs and brains of transgenic B6.Cg-Tg(K18-ACE2)2Prlmn/J (“K18”) and corresponding genetic control (C57BL/6J) mice expressing human angiotensin-converting enzyme 2 (hACE2). Six SARS-CoV-2 variants were assessed: B.1 (WA1-like), alpha, beta, delta, omicron, and omicron XBB.1.5, using cohorts of ≥18 mice. Following intranasal inoculation with B.1, alpha, beta, or delta variants, K18 mice experienced rapid weight loss and reached euthanasia criteria by 5–6 days post-inoculation (dpi). In contrast, K18 mice inoculated with both omicron variants recovered to their starting weight within 4–6 dpi. Infectious SARS-CoV-2 was detected in the oropharynx at 1 and2 dpi, in the lungs at 2, 4, and 6 dpi, and in the brain at 4 and 6 dpi for all variants except omicron. SARS-CoV-2 nucleoprotein was detected, and interstitial pneumonia of varying severity was observed in K18 mice infected with all variants. Brain lesions were identified in mice infected with the B.1, beta, and delta variants 6 dpi. As K18 mice express hACE2 in the brain—a feature not present in humans—we also compared infection dynamics of three variants to those of a mouse-adapted WA1 strain in C57BL/6J mice lacking the human ACE2 gene. C57BL/6J mice did not experience lethal disease, exhibited milder pneumonia, and had no evidence of neuroinvasion despite similar infection kinetics to K18 mice. These findings demonstrate contrasting phenotypes across the two models and reduced tropism and pathology of omicron compared to earlier variants in both models. This comprehensive analysis of SARS-CoV-2 variants in two mouse models provides valuable insights for model and variant selection for future studies. Full article

The transmission dynamics of many pathogens were altered during the coronavirus disease 2019 (COVID-19) pandemic. Several factors, including control measures and social distancing, have influenced the circulation and epidemiology of major etiological agents of meningitis during this period. This review examined trends in the primary etiologic agents of meningitis during and after the COVID-19 pandemic. A comprehensive literature search was conducted using the MEDLINE, Embase, LILACS, and SciELO databases for studies published between 2020 and 2024. The data were summarized descriptively and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-eight studies are included in this review. Bacterial and viral meningitis pathogens exhibited significant epidemiological shifts during the pandemic. A marked decline in infections caused by the enteroviruses, Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae was observed from 2020 to 2021 in the northern and southern hemispheres during the pandemic. Post-pandemic, meningitis cases increased, with a resurgence in various countries. Despite the heterogeneity of the studies, the evidence indicates that the COVID-19 pandemic significantly affected the epidemiology of meningitis-causing microorganisms during and after the pandemic. Understanding these epidemiological shifts and dynamics is crucial for defining the control measures, vaccination strategies, and public health policies in the post-COVID-19 era. Full article

Viral infections have been a severe challenge for global public health, and viral pneumonia is becoming increasingly critical in the post-pandemic era. Observational and basic studies have demonstrated a strong link between host nutrient status and anti-viral immune responses, and nutritional supplements were shown to improve the prognosis of viral infectious diseases. However, there is limited research on the relationship between essential micronutrients and the susceptibility to viral pneumonia. In addition, current studies are often confounded by biases and reverse causality, undermining their reliability. In this study, to fill the gap, we employed Mendelian randomization to investigate the causal relationship between supplementation of vitamins and minerals and the susceptibility to viral pneumonia. Our analysis found that vitamin B6 is a protective factor against viral pneumonia, while selenium supplementation is a risk factor. These findings provide insights for the use of dietary supplements and the prevention and control of viral pneumonia, especially when micronutrient supplementation is used as an adjunctive therapy for viral infections. Full article

Background/Objectives: Since December 2019, the COVID-19 pandemic, driven by SARS-CoV-2, has caused ~690 million infections globally, manifesting with mild to severe symptoms, including pneumonia. After reduced activity, seasonal influenza re-emerged in winter 2022, creating a “twindemic” with SARS-CoV-2. Co-infections have been associated with higher risks, such as increased ventilator use and mortality, emphasizing the need for dual-target vaccines. This study investigates plant-based vaccines produced using a bacterium-like particle (BLP) system from Lactobacillus sakei to co-target SARS-CoV-2 and influenza. Methods: DNA fragments of the SARS-CoV-2 Omicron BA.1 variant spike (S) protein and H1N1 virus hemagglutinin (HA) ectodomain were synthesized and used to create recombinant constructs introduced into Agrobacterium. Protein expression was analyzed using Western blot and Bradford protein assays. Six-week-old K18-hACE2 mice were immunized with these antigens and challenged with influenza, SARS-CoV-2, or both to assess viral load and lung pathology at various times. Results: The SARS-CoV-2 S protein and influenza HA protein were successfully expressed in Nicotiana benthamiana and demonstrated strong binding to BLPs. In mouse models (BALB/c and K18-hACE2), these vaccines elicited potent humoral and cellular immune responses, with high neutralizing antibody titers and increased IFN-γ levels. Vaccinated mice demonstrated protection against viral challenges, reduced lung viral loads, and improved survival. In cases of co-infection, vaccinated mice showed rapid recovery and effective viral clearance, highlighting the potential of vaccines to combat simultaneous SARS-CoV-2 and influenza infections. Conclusions: Our findings highlight the potential of BLP-based multivalent vaccines for dual protection against major public health threats. Full article

The COVID-19 pandemic and Taiwan’s strict prevention policies from May 2020 to April 2023 significantly altered the epidemiology of viral infections. This study analyzed pediatric COVID-19 and influenza cases at Wei Gong Memorial Hospital from January 2015 to March 2024. Clinical features were compared among children hospitalized during the Omicron BA.2.3.7 (April–July 2022), Omicron BA.5 (August–December 2022), and Omicron JN.1 (2024) waves and those with influenza in 2024 and 2015–2016. Between 2015 and 2024, there were 2729 influenza A (36.6%), 974 influenza B (13.1%), and 3752 COVID-19 (50.3%) cases, with 84.7% of COVID-19 cases occurring in May–December 2022. In 2024, high fever (>40 °C) was more common in influenza A cases (32.9%) than in COVID-19 or influenza B (p < 0.004). Leukocytosis (>12,000/µL) was more frequent in COVID-19 cases (33.3%) than in influenza A (12.2%) or B (0%) (p < 0.001). Pneumonia was more prevalent in COVID-19 cases in 2024 (27.3%) than in 2022 (p ≤ 0.030), and pneumonia rates for influenza A (14.8%) and B (16.7%) in 2024 exceeded those in 2015–2016 (p ≤ 0.030). Increased pneumonia rates in 2024 emphasize the importance of vigilance and timely intervention for pediatric COVID-19 and influenza cases. Full article

Background/Objectives: Invasive Streptococcus pneumoniae disease (IPD) and invasive Haemophilus influenzae (IHI) infections cause disease in pediatric patients. The COVID-19 pandemic brought about a change in the rates of common viral illnesses that can lead to superimposed bacterial infections. Methods: A repeated monthly cross-sectional study was performed using inpatient data from the Military Health System Data Repository (MDR) to observe differences in IPD and IHI hospitalization rates before and during the COVID-19 pandemic starting in March 2018 and continuing to February 2023. Our study included a cohort of 1.27 million children under the age of 5 years old. Results: A total of 200 unique cases of IPD and 171 unique cases of IHI were identified. In Year 1 of the pandemic, the hospitalization rates for IHI and IPD decreased. In Year 2, IPD returned to the pre-pandemic baseline, and IHI remained below the baseline. In Year 3, IPD increased above the baseline, and IHI returned to the baseline. Conclusions: These data support the notion that the interventions implemented to reduce the spread of COVID-19, such as hand hygiene and social distancing, likely led to a reduction in the incidence of invasive disease. The subsequent relaxation of these mitigation strategies likely led to a resurgence of IHI and an increase in IPD in our population. Full article

Introduction: COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, which belongs to the coronavirus family. SARS-CoV-2 is related to other viruses that cause severe acute respiratory syndrome. The emergence of cases of pneumonia of unknown origin triggered the largest viral pandemic in modern times, presenting major challenges to global public health. Objective: To analyze the evolution of the COVID-19 pandemic in the state of São Paulo from 2020 to 2023, focusing on trends in incidence, mortality, and lethality. Methods: Ecological study of time series of incidence, mortality and lethality by COVID-19 in the state of São Paulo using Prais-Winsten regression considering the Weekly Percentage Change (WPC) and probability values (p), considering a significance level of 95% (95% CI). To ensure the reliability of the entered data, double-blind typing was performed by different researchers in the same database extracted from the 2024 Ministry of Health Coronavirus dashboard. Results: From February 2020 and the end of December 2023, 6,763,310 accumulated cases and 182,254 deaths were recorded. Stationary trends were observed for the year 2022, with a reduction in incidence and mortality in the year 2023. However, the epidemiological variable lethality showed a stationary trend. Conclusion: The analysis of the trends in incidence, mortality, and lethality revealed variable dynamics over time, with emphasis on the significant reduction of these indicators in 2023. Full article

The COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has profoundly impacted global health, with pneumonia emerging as a major complication in severe cases. The pathogenesis of COVID-19 is marked by the overproduction of reactive oxygen species (ROS) and an excessive inflammatory response, resulting in oxidative stress and significant tissue damage, particularly in the respiratory system. Antioxidants have garnered considerable attention for their potential role in managing COVID-19 pneumonia by mitigating oxidative stress and modulating immune responses. This review provides a comprehensive overview of the literature on the use of antioxidants in hospitalized patients with mild-to-moderate COVID-19. Studies exploring antioxidants, including vitamins, trace elements, nitric oxide (NO), ozone (O₃), glutathione (GSH), L-carnitine, melatonin, bromelain, N-acetylcysteine (NAC), and numerous polyphenols, have yielded promising outcomes. Through their ROS-scavenging properties, these molecules support endothelial function, reduce the thrombosis risk, and may help mitigate the effects of the cytokine storm, a key contributor to COVID-19 morbidity and mortality. Clinical evidence suggests that antioxidant supplementation may improve patient outcomes by decreasing inflammation, supporting immune cell function, and potentially shortening recovery times. Furthermore, these molecules may mitigate the symptoms of COVID-19 by exerting direct antiviral effects that inhibit the infection process and genomic replication of SARS-CoV-2 in host cells. Moreover, antioxidants may work synergistically with standard antiviral treatments to reduce viral-induced oxidative damage. By integrating findings from the literature with real-world data from our clinical experience, we gain a more profound understanding of the role of antioxidants in managing COVID-19 pneumonia. Further research combining comprehensive literature reviews with real-world data analysis is crucial to validate the efficacy of antioxidants and establish evidence-based guidelines for their use in clinical practice. Full article

On 11 February 2020, the prevalent outbreak of COVID-19, a coronavirus illness, was declared a global pandemic. Since then, nearly seven million people have died and over 765 million confirmed cases of COVID-19 have been reported. The goal of this study is to develop a diagnostic tool for detecting COVID-19 infections more efficiently. Currently, the most widely used method is Reverse Transcription Polymerase Chain Reaction (RT-PCR), a clinical technique for infection identification. However, RT-PCR is expensive, has limited sensitivity, and requires specialized medical expertise. One of the major challenges in the rapid diagnosis of COVID-19 is the need for reliable imaging, particularly X-ray imaging. This work takes advantage of artificial intelligence (AI) techniques to enhance diagnostic accuracy by automating the detection of COVID-19 infections from chest X-ray (CXR) images. We obtained and analyzed CXR images from the Kaggle public database (4035 images in total), including cases of COVID-19, viral pneumonia, pulmonary opacity, and healthy controls. By integrating advanced techniques with transfer learning from pre-trained convolutional neural networks (CNNs), specifically InceptionV3, ResNet50, and Xception, we achieved an accuracy of 95%, significantly higher than the 85.5% achieved with ResNet50 alone. Additionally, our proposed method, CXR-DNNs, can accurately distinguish between three different types of chest X-ray images for the first time. This computer-assisted diagnostic tool has the potential to significantly enhance the speed and accuracy of COVID-19 diagnoses. Full article

Background/Objectives: Acute exacerbation (AE) of interstitial lung disease (ILD) is a major challenge. This study aimed to retrospectively investigate occurrences of AEs in patients with ILDs, including idiopathic pulmonary fibrosis (IPF), non-IPF (iNSIP: idiopathic nonspecific interstitial pneumonia), and connective tissue disease (CTD)-associated ILDs (CTD-ILDs), at a single tertiary center before and after the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to clarify the seasonal and regional trends of AEs of ILDs, assess the roles of viral and bacterial infections, and identify key prognostic factors for patient outcomes. Methods: We conducted a retrospective review of hospitalized adult patients with AEs of ILDs from January 2019 to February 2024. Results: A total of 93 patients were enrolled: IPF (n = 42), iNSIP (n = 37), and CTD-ILDs (n = 14). The median age was 80 years (interquartile range: 74.0–86.0 years), with males comprising 64.5% (n = 60). AEs of ILDs predominantly occurred in winter and were particularly notable after summer 2023, coinciding with the lifting of COVID-19-related travel restrictions in Japan. Patient referrals from different areas (Northern Tama, East and/or Southern Tama, and other Tokyo metropolitan areas) were evenly distributed throughout the study period. Viral infections were detected in only two patients (SARS-CoV-2), and bacterial infections included methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. The Cox regression analysis identified serum lactate dehydrogenase levels ≥350 IU/L and tachypnea (respiratory rate ≥ 30 breaths per min) on admission as prognostic factors for mortality, with a hazard ratio [HR] of 2.783 (95% confidence interval [CI]: 1.480–5.235, p = 0.001) and an HR of 3.332 (95% CI: 1.710–6.492, p < 0.001), respectively. Conclusions: AEs of ILDs predominantly occur in winter, and viral and bacterial infections are infrequently detected. Elevated serum LDH levels and tachypnea are crucial prognostic markers for mortality. This study highlights the seasonal trend in the AE of ILD and emphasizes the importance of specific prognostic indicators in clinical practice. Full article

Coronavirus disease (COVID-19) is caused by the SARS-CoV-2 virus and has been declared as a pandemic. The early detection of COVID-19 is necessary to interrupt the spread of the virus and prevent its transmission. X-rays and CT scans can assist radiologists in disease detection. However, detecting COVID-19 on chest radiographs is challenging due to similarities with other bacterial and viral pneumonias. Therefore, it is essential to develop a fast and accurate algorithm for detecting COVID-19. In this work, we applied pre-processing in order to increase the contrast in X-rays. We then use the ResNet-50 model to differentiate between normal and COVID-19 images. Images classified as COVID-19 were investigated with an ensemble detection model (deep learning models—You Only Look Once version 5 and X). The classification model achieved an accuracy of 0.864 and an AUC of 0.904 in 5-fold cross-validation. The overlap between the predicted bounding boxes and the ground truth reached, in the ensemble model, a mAP of 59.63% in 5-fold cross-validation. Thus, we consider that the result was significant in terms of the global classification of the images, as well as in the location of suspicious regions that require greater attention from the specialist, which makes the developed model a fast and promising way to aid the specialist in decision making. Full article

The COVID-19 pandemic has altered respiratory infection patterns in pediatric populations. The emergence of the SARS-CoV-2 Omicron variant and relaxation of public health measures have increased the likelihood of coinfections. Previous studies show conflicting results regarding the impact of viral and bacterial coinfections with SARS-CoV-2 on severity of pediatric disease. This study investigated the prevalence and clinical impact of coinfections among children hospitalized with COVID-19 during the Omicron wave. A retrospective analysis was conducted on 574 hospitalized patients aged under 18 years in Russia, from January 2022 to March 2023. Samples from patients were tested for SARS-CoV-2 and other respiratory pathogens using qRT-PCR, bacterial culture tests and mass spectrometry, and ELISA. Approximately one-third of COVID-19 cases had coinfections, with viral and bacterial coinfections occurring at similar rates. Adenovirus and Staphylococcus aureus were the most common viral and bacterial coinfections, respectively. Viral coinfections were associated with higher fevers and increased bronchitis, while bacterial coinfections correlated with longer duration of illness and higher pneumonia rates. Non-SARS-CoV-2 respiratory viruses were linked to more severe lower respiratory tract complications than SARS-CoV-2 monoinfection. These findings suggest that during the Omicron wave, seasonal respiratory viruses may have posed a greater threat to children’s health than SARS-CoV-2. Full article