Clinical Predictors of Influenza in Children

Total Page:16

File Type:pdf, Size:1020Kb

Clinical Predictors of Influenza in Children ARTICLE Clinical Predictors of Influenza in Children Marla J. Friedman, DO; Magdy W. Attia, MD Background: It is difficult to diagnose influenza infec- Results: The mean±SD age of patients was 6.2±5.2 years; tion on clinical grounds alone. Available rapid diagnos- 50% were boys. Viral isolates included the following: in- tic tests have limited sensitivities. fluenza A, 45 patients (35%); influenza B, 13 (10%); other viruses, 10 (8%); negative results, 60 (47%). Demo- Objective: To develop a prediction model that identi- graphic and clinical findings were not significantly differ- fies children likely to have influenza infection. ent between the influenza A and influenza B groups. Cough (P=.003), headache (P=.04), and pharyngitis (P=.04) were Design: Prospective study. independently associated with influenza infection. This triad used as a prediction model for influenza infection had a Setting: Emergency department of a children’s hospital. sensitivity of 80% (95% confidence interval [CI], 69%- 91%); specificity, 78% (95% CI, 67%-89%); and likeli- Patients: All patients with a febrile respiratory illness hood ratio for a positive viral culture for influenza, 3.7 (95% during the influenza season of winter 2002 were eli- CI, 2.3-6.3). The posttest probability of this clinical defi- gible. A prospective sample of 128 children who were sus- nition is 77% (95% CI, 63%-91%). pected of having influenza infection based on predeter- mined criteria was enrolled. Each patient received a nasal Conclusion: The triad of cough, headache, and phar- wash for viral culture. yngitis is a predictor of influenza infection in children. Main Outcome Measure: Clinical features that are most predictive of influenza infection in children. Arch Pediatr Adolesc Med. 2004;158:391-394 NFLUENZA IS A COMMON FEBRILE dren, but no characteristic symptom or illness with a significant impact symptom complex has been identified. Re- on the pediatric population. Dur- ported manifestations of influenza in chil- ing annual outbreaks, 15% to 20% dren include abrupt onset of high fever, of children are infected with in- coryza, cough, sore throat, vomiting, di- Ifluenza.1,2 Estimates of annual outpatient arrhea, abdominal pain, fatigue, head- visits attributable to influenza range from ache, and myalgias. The classic symp- 6 to 29 per 100 visits.3,4 School absentee- toms often associated with influenza in ism, parental work absenteeism, and sec- adults are not easily identified in chil- ondary illness among family members are dren. all significantly higher during influenza The gold standard for diagnosing in- season than throughout the rest of the win- fluenza infection is viral isolation by cul- 5 From the Department of ter. Infants and young children are hos- ture. However, viral culture results are not Pediatrics, Division of pitalized for influenza-associated ill- available in time to influence patient man- Emergency Medicine, nesses at rates comparable with those of agement. The rapid tests available to di- Alfred I. duPont Hospital for high-risk adults and elderly patients.3,6 Fur- agnose influenza are limited by their di- Children, Wilmington, Del; and thermore, influenza is commonly impli- agnostic abilities. A review of the studies Jefferson Medical College, cated as a cause of nosocomial infections performed on commercially available rapid Thomas Jefferson University, in pediatric inpatient units.7,8 tests reveals great variability in the sensi- Philadelphia, Pa. Dr Friedman is now with the Department of The nonspecific presentation of in- tivities (40%-100%), specificities (63%- Pediatrics, Division of fluenza infection makes it difficult to dis- 100%), positive predictive values (PPVs) Emergency Medicine, Miami tinguish from other febrile or respiratory (43%-100%), and negative predictive val- Children’s Hospital, illnesses. Many clinical features have been ues (56%-100%) of these tests. The higher Miami, Fla. associated with influenza illness in chil- sensitivities are often difficult to repro- (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 158, APR 2004 WWW.ARCHPEDIATRICS.COM 391 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 duce in clinical practice, and false-negative results are This study was approved with consent waiver by the in- likely to occur.9 As predictive values are affected by dis- stitutional review board of our institution (Alfred I. duPont Hos- ease prevalence, these diagnostic tests are most helpful pital for Children). during periods of high influenza activity. However, it seems impractical and inefficient to test each patient with STUDY PERIOD suspected influenza infection, even during peak season. The beginning of influenza season was defined as the period The diagnostic abilities of these tests can be enhanced if following the detection of 2 consecutive isolates in one week patients with a high likelihood of influenza infection are of either influenza A or influenza B from viral culture in the selected for testing based on a set of clinical criteria. Dif- community. The season ended with the identification of the ferentiating influenza infection from infection caused by last of 2 consecutive isolates in one week. Patients were en- other respiratory pathogens is important for several rea- rolled from January 14, 2002, through March 29, 2002. sons. From a public health perspective, understanding the magnitude of illness attributable to influenza is cru- VIROLOGIC ANALYSIS cial for surveillance data across communities and states. Local and national surveillance is useful for predicting Viral culture specimens from nasal washes were inoculated onto human lung tissue (MRC-5) cells, rhesus monkey kid- health care resource needs (hospital beds, staffing, sup- ney cells, human embryonic kidney (HEK) cells, human epi- ply of diagnostic tests and antivirals needed) and for de- dermoid laryngeal carcinoma (Hep-2) cells, and human lung 10 tecting pandemics. Furthermore, children are consid- carcinoma (A-549) cells. These cells were incubated at ered an important factor in this process by introducing 34.5°C and observed daily for 28 days for cytopathic effect. infection into the home and transmitting it to adult and All viruses isolated by culture were confirmed by immuno- elderly patients.1 Timely diagnosis is imperative for the fluorescence staining. initiation of appropriate antiviral treatment and for the proper isolation of hospitalized patients. Both of these STATISTICAL ANALYSIS interventions may aid in reducing the overall disease im- pact. These many factors argue for enhancing the clini- The primary outcome measures were the clinical features that are most predictive of influenza infection in children. cal prediction of this disease. Interobserver agreement was evaluated for each of the clini- The purpose of this study was to identify a clinical cal examination findings. Two physicians performed separate prediction model for influenza infection in children. examinations and recorded their observations independently. Data was analyzed for agreement rates, and by ␬ statistics. METHODS Sample size was calculated to detect a 30% difference be- tween assumed prevalence of influenza in tested patients (a 50-50 DESIGN AND DEFINITIONS chance, or 50%) and the hypothesis that a prediction model will possess a sensitivity that is approximately equal to rapid This prospective study was conducted during the 2002 influ- test (80%). After continuity correction, a sample size of 45 pa- enza season (January-March). All patients (birth through age tients in each of 2 groups representing influenza-positive and 17 years) who were seen in the emergency department of a sub- influenza-negative patients was estimated. urban tertiary pediatric center with a febrile respiratory illness Demographic and clinical findings of patients with influ- were eligible. A consecutive sample of children suspected of enza A and influenza B were compared with each other using ϫ having influenza infection were enrolled. Enrollment criteria 2 2 contingency tables, independent sample t test, or Mann- included fever and at least one of the following symptoms: co- Whitney U test, depending on their parametric distribution. A ryza, cough, headache, sore throat, or muscle aches. Fever was univariate analysis was then performed on all influenza pa- defined as an emergency department temperature higher than tients as a group compared with those patients who had no vi- 38°C or history of similar temperature within the previous 24 ral pathogen isolated. A binary logistic regression analysis us- hours. All enrolled patients received a nasal wash for viral cul- ing backwards stepwise elimination was performed to identify ture. At the time of evaluation, a standardized data collection variables independently associated with influenza infection. Fe- form was completed by the physician for each enrolled pa- ver greater than or equal to 39°C was entered as a dichoto- tient. Demographic information, duration of illness, day care mized variable. To simplify the analysis, the remainder of the attendance, and triage vital signs were recorded for each pa- vital signs were not included. All tests were 2-tailed and con- Յ tient. The presence or absence of 24 clinical features (12 his- sidered significant at P .05. Statistical analyses were per- torical features and 12 physical examination findings) was noted formed using SPSS version 11.5 (SPSS Inc, Chicago, Ill). on the same form. The historical features were recorded as di- chotomous
Recommended publications
  • Influenza Virus Infections in Humans October 2018
    Influenza virus infections in humans October 2018 This note is provided in order to clarify the differences among seasonal influenza, pandemic influenza, and zoonotic or variant influenza. Seasonal influenza Seasonal influenza viruses circulate and cause disease in humans every year. In temperate climates, disease tends to occur seasonally in the winter months, spreading from person-to- person through sneezing, coughing, or touching contaminated surfaces. Seasonal influenza viruses can cause mild to severe illness and even death, particularly in some high-risk individuals. Persons at increased risk for severe disease include pregnant women, the very young and very old, immune-compromised people, and people with chronic underlying medical conditions. Seasonal influenza viruses evolve continuously, which means that people can get infected multiple times throughout their lives. Therefore the components of seasonal influenza vaccines are reviewed frequently (currently biannually) and updated periodically to ensure continued effectiveness of the vaccines. There are three large groupings or types of seasonal influenza viruses, labeled A, B, and C. Type A influenza viruses are further divided into subtypes according to the specific variety and combinations of two proteins that occur on the surface of the virus, the hemagglutinin or “H” protein and the neuraminidase or “N” protein. Currently, influenza A(H1N1) and A(H3N2) are the circulating seasonal influenza A virus subtypes. This seasonal A(H1N1) virus is the same virus that caused the 2009 influenza pandemic, as it is now circulating seasonally. In addition, there are two type B viruses that are also circulating as seasonal influenza viruses, which are named after the areas where they were first identified, Victoria lineage and Yamagata lineage.
    [Show full text]
  • Case 16-2019: a 53-Year-Old Man with Cough and Eosinophilia
    The new england journal of medicine Case Records of the Massachusetts General Hospital Founded by Richard C. Cabot Eric S. Rosenberg, M.D., Editor Virginia M. Pierce, M.D., David M. Dudzinski, M.D., Meridale V. Baggett, M.D., Dennis C. Sgroi, M.D., Jo-Anne O. Shepard, M.D., Associate Editors Alyssa Y. Castillo, M.D., Case Records Editorial Fellow Emily K. McDonald, Sally H. Ebeling, Production Editors Case 16-2019: A 53-Year-Old Man with Cough and Eosinophilia Rachel P. Simmons, M.D., David M. Dudzinski, M.D., Jo-Anne O. Shepard, M.D., Rocio M. Hurtado, M.D., and K.C. Coffey, M.D.​​ Presentation of Case From the Department of Medicine, Bos- Dr. David M. Dudzinski: A 53-year-old man was evaluated in an urgent care clinic of ton Medical Center (R.P.S.), the Depart- this hospital for 3 months of cough. ment of Medicine, Boston University School of Medicine (R.P.S.), the Depart- Five years before the current evaluation, the patient began to have exertional ments of Medicine (D.M.D., R.M.H.), dyspnea and received a diagnosis of hypertrophic obstructive cardiomyopathy, with Radiology (J.-A.O.S.), and Pathology a resting left ventricular outflow gradient of 110 mm Hg on echocardiography. (K.C.C.), Massachusetts General Hos- pital, and the Departments of Medicine Although he received medical therapy, symptoms persisted, and percutaneous (D.M.D., R.M.H.), Radiology (J.-A.O.S.), alcohol septal ablation was performed 1 year before the current evaluation, with and Pathology (K.C.C.), Harvard Medical resolution of the exertional dyspnea.
    [Show full text]
  • Care Process Models Streptococcal Pharyngitis
    Care Process Model MONTH MARCH 20152019 DEVELOPMENTDIAGNOSIS AND AND MANAGEMENT DESIGN OF OF CareStreptococcal Process Models Pharyngitis 20192015 Update This care process model (CPM) was developed by Intermountain Healthcare’s Antibiotic Stewardship team, Medical Speciality Clinical Program,Community-Based Care, and Intermountain Pediatrics. Based on expert opinion and the Infectious Disease Society of America (IDSA) Clinical Practice Guidelines, it provides best-practice recommendations for diagnosis and management of group A streptococcal pharyngitis (strep) including the appropriate use of antibiotics. WHAT’S INSIDE? KEY POINTS ALGORITHM 1: DIAGNOSIS AND TREATMENT OF PEDIATRIC • Accurate diagnosis and appropriate treatment can prevent serious STREPTOCOCCAL PHARYNGITIS complications . When strep is present, appropriate antibiotics can prevent AGES 3 – 18 . 2 SHU acute rheumatic fever, peritonsillar abscess, and other invasive infections. ALGORITHM 2: DIAGNOSIS Treatment also decreases spread of infection and improves clinical AND TREATMENT OF ADULT symptoms and signs for the patient. STREPTOCOCCAL PHARYNGITIS . 4 • Differentiating between a patient with an active strep infection PHARYNGEAL CARRIERS . 6 and a patient who is a strep carrier with an active viral pharyngitis RESOURCES AND REFERENCES . 7 is challenging . Treating patients for active strep infection when they are only carriers can result in overuse of antibiotics. Approximately 20% of asymptomatic school-aged children may be strep carriers, and a throat culture during a viral illness may yield positive results, but not require antibiotic treatment. SHU Prescribing repeat antibiotics will not help these patients and can MEASUREMENT & GOALS contribute to antibiotic resistance. • Ensure appropriate use of throat • For adult patients, routine overnight cultures after a negative rapid culture for adult patients who meet high risk criteria strep test are unnecessary in usual circumstances because the risk for acute rheumatic fever is exceptionally low.
    [Show full text]
  • Call to Action: the Dangers of Influenza and COVID-19 in Adults
    Call to Action The Dangers of Influenza and COVID-19 in Adults with Chronic Health Conditions October 2020 Experts urge all healthcare professionals to prioritize influenza vaccination to help protect adults with chronic health conditions during the COVID-19 pandemic The recommendations in this Call to Action are based on discussions from an Call to Action August 2020 Roundtable convened by the National Foundation for Infectious The Dangers of Influenza Diseases (NFID). The multidisciplinary and COVID-19 in Adults with group of subject matter experts Chronic Health Conditions explored the risks of co-circulation and co-infection with influenza and SARS-CoV-2 viruses in adults with chronic Overview health conditions from the perspective While every influenza (flu) season is unpredictable, of their specialized areas of medicine the 2020-2021 season is characterized by an and discussed strategies to protect unprecedented dual threat: co-circulation of these vulnerable populations. influenza and the novel coronavirus (SARS-CoV-2) that causes COVID-19. Moreover, there is concern Experts agreed that higher levels of that co-circulation and co-infection with influenza influenza vaccination coverage during and COVID-19 viruses could be especially harmful, the 2020-2021 influenza season could particularly among adults at increased risk of reduce the number of influenza-related influenza-related complications. hospitalizations, helping to avoid Influenza poses serious health risks to adults unnecessary strain on the US healthcare with certain chronic health conditions including system during the COVID-19 pandemic, heart disease, lung disease, and diabetes. The so that healthcare facilities have the increased risk of influenza-related complications capacity to provide care to patients includes the potential exacerbation of underlying with COVID-19.
    [Show full text]
  • Diagnosis and Treatment of Acute Pharyngitis/Tonsillitis: a Preliminary Observational Study in General Medicine
    Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2016; 20: 4950-4954 Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine F. DI MUZIO, M. BARUCCO, F. GUERRIERO Azienda Sanitaria Locale Roma 4, Rome, Italy Abstract. – OBJECTIVE : According to re - pharmaceutical expenditure, without neglecting cent observations, the insufficiently targeted the more important and correct application of use of antibiotics is creating increasingly resis - the Guidelines with performing of a clinically val - tant bacterial strains. In this context, it seems idated test that carries advantages for reducing increasingly clear the need to resort to extreme the use of unnecessary and potentially harmful and prudent rationalization of antibiotic thera - antibiotics and the consequent lower prevalence py, especially by the physicians working in pri - and incidence of antibiotic-resistant bacterial mary care units. In clinical practice, actually the strains. general practitioner often treats multiple dis - eases without having the proper equipment. In Key Words: particular, the use of a dedicated, easy to use Acute pharyngitis, Tonsillitis, Strep throat, Beta-he - diagnostic test would be one more weapon for molytic streptococcus Group A (GABHS), Rapid anti - the correct diagnosis and treatment of acute gen detection test, Appropriateness use of antibiotics, pharyngo-tonsillitis. The disease is a condition Cost savings in pharmaceutical spending. frequently encountered in clinical practice but
    [Show full text]
  • Common Questions About Streptococcal Pharyngitis MONICA G
    Common Questions About Streptococcal Pharyngitis MONICA G. KALRA, DO, Memorial Family Medicine Residency, Sugar Land, Texas KIM E. HIGGINS, DO, Envoy Hospice and Brookdale Hospice, Fort Worth, Texas EVAN D. PEREZ, MD, Memorial Family Medicine Residency, Sugar Land, Texas Group A beta-hemolytic streptococcal (GABHS) infection causes 15% to 30% of sore throats in children and 5% to 15% in adults, and is more common in the late winter and early spring. The strongest independent predictors of GABHS pharyngitis are patient age of five to 15 years, absence of cough, tender anterior cervical adenopa- thy, tonsillar exudates, and fever. To diagnose GABHS pharyngitis, a rapid antigen detection test should be ordered in patients with a modified Centor or FeverPAIN score of 2 or 3. First-line treatment for GABHS pharyngitis includes a 10-day course of penicillin or amoxicillin. Patients allergic to penicillin can be treated with first- generation cephalosporins, clindamycin, or macrolide antibiotics. Nonsteroidal anti-inflammatory drugs are more effective than acet- aminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis; medicated throat lozenges used every two hours are also effective. Corticosteroids provide only a small reduc- tion in the duration of symptoms and should not be used routinely. (Am Fam Physician. 2016;94(1):24-31. Copyright © 2016 American Academy of Family Physicians.) ILLUSTRATION JOHN BY KARAPELOU CME This clinical content haryngitis is diagnosed in 11 mil- EVIDENCE SUMMARY conforms to AAFP criteria lion persons in the outpatient set- Several risk factors should increase the index for continuing medical 1 education (CME). See ting each year in the United States.
    [Show full text]
  • Bronchiolitis
    Bronchiolitis What is bronchiolitis? Bronchiolitis is a viral infection of the lungs that usually affects infants. There is swelling in the smaller airways or bronchioles of the lung, which causes coughing and wheezing. Bronchiolitis is the most common reason for children under 1 year old to be admitted to the hospital. What are the symptoms of bronchiolitis? The following are the most common symptoms of bronchiolitis. However, each child may experience symptoms differently. Symptoms may include: Runny nose or nasal congestion Fever Cough Changes in breathing patterns (wheezing and breathing faster or harder are common) Decreased appetite Fussiness Vomiting What causes bronchiolitis? Bronchiolitis is a common illness caused by different viruses. The most common virus causing this infection is Respiratory Syncytial Virus (RSV). However, many other viruses can cause bronchiolitis including: Influenza, Parainfluenza, Rhinovirus, Adenovirus, and Human metapneumovirus. Initially, the virus causes an infection in the upper airways, and then spreads downward into the lower airways of the lungs. The virus causes swelling of the airways. Mucus is also produced in the airways. This narrowing of the airways can make it difficult for your child to breath, eat, or nurse. How is bronchiolitis diagnosed? Bronchiolitis is usually diagnosed on the history and physical examination of the child. Antibiotics are not helpful in treating viruses and are not needed to treat bronchiolitis. Because there is no cure for the disease, the goal of treatment is to make your child comfortable and to support their symptoms. This treatment may include suctioning to keep the airways clear, extra oxygen if the blood oxygen levels are low, or hydration if your child is not able to feed well.
    [Show full text]
  • Avian Influenza Outbreaks in the United States Q&A
    USDA Questions and Answers: Avian Influenza Outbreaks in the United States April 2015 Avian Influenza in the United States Q. Does highly pathogenic avian influenza currently exist in the United States? A. Since mid-December 2014, there have been several ongoing highly pathogenic avian influenza (HPAI) H5 incidents along the Pacific, Central and Mississippi Flyways. Cases in wild birds, captive wild birds, backyard poultry or commercial poultry have been reported in Arkansas, California, Iowa, Idaho, Kansas, Minnesota, Missouri, Montana, North Dakota, Nevada, Oregon, Utah, South Dakota, Washington, Wisconsin and Wyoming. Details are available on the APHIS website. The HPAI strains detected recently in these flyways are H5N2, H5N8 and H5N1, but primarily H5N2 in turkey flocks. Q. Can people catch these highly pathogenic avian influenza strains that are being detected in these outbreaks? A. CDC considers the risk to people from these HPAI H5 viruses in wild birds, backyard flocks, and commercial poultry, to be low. No human infections with these viruses have been detected at this time, however, similar viruses have infected people. It’s possible that human infections with these viruses may occur. While human infections are possible, infection with avian influenza viruses in general are rare and – when they occur – these viruses have not spread easily to other people. These reports of H5-infected wild birds and poultry in the United States do not signal the start of a pandemic. Q. How is USDA dealing with these HPAI outbreaks? A. The United States has the strongest AI surveillance program in the world so that the food supply remains safe.
    [Show full text]
  • Pediatric Ambulatory Community Acquired Pneumonia (CAP)
    ANMC Pediatric (≥3mo) Ambulatory Community Acquired Pneumonia (CAP) Treatment Guideline Criteria for Respiratory Distress Criteria For Outpatient Management Testing/Imaging for Outpatient Management Tachypnea, in breaths/min: Mild CAP: no signs of respiratory distress Vital Signs: Standard VS and Pulse Oximetry Age 0-2mo: >60 Able to tolerate PO Labs: No routine labs indicated Age 2-12mo: >50 No concerns for pathogen with increased virulence Influenza PCR during influenza season Age 1-5yo: >40 (ex. CA-MRSA) Blood cultures if not fully immunized OR fails to Age >5yo: >20 Family able to carefully observe child at home, comply improve/worsens after initiation of antibiotics Dyspnea with therapy plan, and attend follow up appointments Urinary antigen detection testing is not Retractions recommended in children; false-positive tests are common. Grunting If patient does not meet outpatient management criteria Radiography: No routine CXR indicated Nasal flaring refer to inpatient pneumonia guideline for initial workup Apnea and testing. AP and lateral CXR if fails initial antibiotic therapy Altered mental status AP and lateral CXR 4-6 weeks after diagnosis if Pulse oximetry <90% on room air recurrent pneumonia involving the same lobe Treatment Selection Suspected Viral Pneumonia Most Common Pathogens: Influenza A & B, Adenovirus, Respiratory Syncytial Virus, Parainfluenza No antimicrobial therapy is necessary. Most common in <5yo If influenza positive, see influenza guidelines for treatment algorithm. Suspected Bacterial
    [Show full text]
  • Nebulised N-Acetylcysteine for Unresponsive Bronchial Obstruction in Allergic Brochopulmonary Aspergillosis: a Case Series and Review of the Literature
    Journal of Fungi Review Nebulised N-Acetylcysteine for Unresponsive Bronchial Obstruction in Allergic Brochopulmonary Aspergillosis: A Case Series and Review of the Literature Akaninyene Otu 1,2,*, Philip Langridge 2 and David W. Denning 2,3 1 Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State P.M.B. 1115, Nigeria 2 The National Aspergillosis Centre, 2nd Floor Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; [email protected] (P.L.); [email protected] (D.W.D.) 3 Faculty of Biology, Medicine and Health, The University of Manchester, and Manchester Academic Health Science Centre, Oxford Rd, Manchester M13 9PL, UK * Correspondence: [email protected] Received: 5 September 2018; Accepted: 8 October 2018; Published: 15 October 2018 Abstract: Many chronic lung diseases are characterized by the hypersecretion of mucus. In these conditions, the administration of mucoactive agents is often indicated as adjuvant therapy. N-acetylcysteine (NAC) is a typical example of a mucolytic agent. A retrospective review of patients with pulmonary aspergillosis treated at the National Aspergillosis Centre in Manchester, United Kingdom, with NAC between November 2015 and November 2017 was carried out. Six Caucasians with Aspergillus lung disease received NAC to facilitate clearance of their viscid bronchial mucus secretions. One patient developed immediate bronchospasm on the first dose and could not be treated. Of the remainder, two (33%) derived benefit, with increased expectoration and reduced symptoms. Continued response was sustained over 6–7 months, without any apparent toxicity. In addition, a systematic review of the literature is provided to analyze the utility of NAC in the management of respiratory conditions which have unresponsive bronchial obstruction as a feature.
    [Show full text]
  • The Effect of Corticosteroids on Mortality of Patients with Influenza
    Ni et al. Critical Care (2019) 23:99 https://doi.org/10.1186/s13054-019-2395-8 RESEARCH Open Access The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis Yue-Nan Ni1, Guo Chen2, Jiankui Sun3, Bin-Miao Liang1* and Zong-An Liang1 Abstract Background: The effect of corticosteroids on clinical outcomes in patients with influenza pneumonia remains controversial. We aimed to further evaluate the influence of corticosteroids on mortality in adult patients with influenza pneumonia by comparing corticosteroid-treated and placebo-treated patients. Methods: The PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Information Sciences Institute (ISI) Web of Science databases were searched for all controlled studies that compared the effects of corticosteroids and placebo in adult patients with influenza pneumonia. The primary outcome was mortality, and the secondary outcomes were mechanical ventilation (MV) days, length of stay in the intensive care unit (ICU LOS), and the rate of secondary infection. Results: Ten trials involving 6548 patients were pooled in our final analysis. Significant heterogeneity was found in all outcome measures except for ICU LOS (I2 =38%,P = 0.21). Compared with placebo, corticosteroids were associated with higher mortality (risk ratio [RR] 1.75, 95% confidence interval [CI] 1.30 ~ 2.36, Z =3.71,P = 0.0002), longer ICU LOS (mean difference [MD] 2.14, 95% CI 1.17 ~ 3.10, Z =4.35,P < 0.0001), and a higher rate of secondary infection (RR 1.98, 95% CI 1.04 ~ 3.78, Z = 2.08, P = 0.04) but not MV days (MD 0.81, 95% CI − 1.23 ~ 2.84, Z =0.78,P = 0.44) in patients with influenza pneumonia.
    [Show full text]
  • Rise in Children Presenting with Periodic Fever, Aphthous Stomatitis, Pharyngitis and Adenitis Syndrome During the COVID-19 Pandemic
    Letter Arch Dis Child: first published as 10.1136/archdischild-2021-322792 on 22 July 2021. Downloaded from Rise in children presenting with periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome during the COVID-19 pandemic Periodic fever, aphthous stomatitis, phar- yngitis and adenitis (PFAPA) syndrome is characterised by episodes of fever lasting a few days that classically exhibit clockwork periodicity. Since the initial description of PFAPA syndrome by Gary Marshall in 1987, it has been recognised that stomatitis, pharyngitis and adenitis Figure 1 Rise in children presenting with PFAPA syndrome during the COVID-19 pandemic. are variably present.1 Its phenotype is Children with a new diagnosis of PFAPA syndrome as absolute number (black circles) and consistent with an autoinflammatory as proportion of overall referrals (grey circles) to the tertiary paediatric immunology and condition of unknown genetic aetiology rheumatology outpatient clinics at Bristol Royal Hospital for Children (2015–2020). possibly involving an infectious/environ- mental trigger, given that a family history is present in approximately 27% of cases.2 their characteristics were similar to chil- condition was already increasing. Third, The natural history is onset before 6 years dren diagnosed in the pre-pandemic era many of our cohort underwent multiple old, followed by spontaneous resolution (figure 1 and table 1). In comparison, SARS- CoV-2 tests, and the disruption by 15 years. Treatment with colchicine there was a modest overall increase in associated with repeated periods of house- can reduce the frequency of episodes and referrals to the service (incidence rate hold self- isolation may have contributed tonsillectomy is usually curative.3 ratio 1.71; 95% CI 1.46 to 2.00).
    [Show full text]