High #risk of hypoxemic #COVID19 #pneumonia in #myasthenia gravis patients with type I IFN #autoantibodies

 

Abstract

Patients with myasthenia gravis (MG) may produce autoantibodies neutralizing type I interferons (AAN-I-IFN), which have been shown to underlie severe viral diseases, including critical COVID-19 pneumonia, in patients without MG. We studied an international cohort of 85 unvaccinated SARS-CoV-2-infected MG patients with no antiviral treatment. Hypoxemic pneumonia occurred in 48 of these patients, including 22 (45.8%) with AAN-I-IFN, which neutralized both IFN-α2 and IFN-ω in 14 (29.2%) patients. Six (16.2%) of the remaining 37 patients had AAN-I-IFN, which neutralized both IFN-α2 and IFN-ω in three patients. The risk of hypoxemic pneumonia was greater in MG patients with AAN-I-IFN neutralizing 10 ng/mL of both IFN-α2 and IFN-ω (odds ratio and 95% confidence interval (OR [95% CI]): 12.7 [2.1-78.9], p=0. 0010) or IFN-α2 at any dose (4.7 [1.5-15.0], p=0.0054) than in those without such autoantibodies. The risk of AAN-I-IFN production was much higher in MG patients than in the general population (28.9 [10.8-77.7], p=4.9x10-27). Fourteen patients had thymoma, which increased the risk of AAN-I-IFN (64% versus 27%, (OR [95% CI]: 5.6 [1.6-19.4], p=0.0050) and hypoxemic pneumonia (9.2 [1.9-44.2]; p=0.0019). Thymoma is, thus, associated with a higher risk of producing AAN-I-IFN, and these autoantibodies are associated with a higher risk of developing life-threatening COVID-19 pneumonia in patients with MG.

Competing Interest Statement

J.-L. C. is an inventor on patent application PCT/US2021/042741, filed July 22, 2021, submitted by The Rockefeller University and covering the diagnosis of susceptibility to, and the treatment of, viral disease, and viral vaccines, including COVID-19 and vaccine-associated diseases. None of the other authors has any conflict of interest to declare.

Funding Statement

The Laboratory of Human Genetics of Infectious Diseases is supported by the Howard Hughes Medical Institute, the Rockefeller University, the St. Giles Foundation, the National Institutes of Health (NIH) (R01AI163029), the National Center for Advancing Translational Sciences (NCATS), NIH Clinical and Translational Science Award (CTSA) program (UL1TR001866), the Fisher Center for Alzheimer s Research Foundation, the Meyer Foundation, the JPB Foundation, the Stavros Niarchos Foundation (SNF) as part of its grant to the SNF Institute for Global Infectious Disease Research at The Rockefeller University, the French Agence Nationale de la Recherche (ANR) under the France 2030 program (ANR-10-IAHU-01), the Integrative Biology of Emerging Infectious Diseases Laboratory of Excellence (ANR-10-LABX-62-IBEID), the French Foundation for Medical Research (FRM) (EQU202503020018), the ANR-RHU program ANR-21-RHUS-0008, ANR GENVIR (ANR-20-CE93-0003), ANR AABIFNCOV (ANR-20-CO11-0001) and ANR GenMISC (ANR-21-COVR-0039), AI2D (ANR-22-CE15-0046) projects, the European Union s Horizon 2020 research and innovation program under grant agreement no. 824110 (EASI-genomics), the HORIZON-HLTH-2021-DISEASE-04 program under grant agreement 101057100 (UNDINE), the Square Foundation, Grandir - Fonds de solidarite pour l enfance, the Fondation du Souffle, the SCOR Corporate Foundation for Science, the Battersea and Bowery Advisory Group; The French Ministry of Higher Education, Research, and Innovation (MESRI-COVID-19), William E. Ford, General Atlantic s Chairman and Chief Executive Officer, Gabriel Caillaux, General Atlantic s Co-President, Managing Director and Head of Business in EMEA, and the General Atlantic Foundation, Institut National de la Sante et de la Recherche Medicale (INSERM), REACTing-INSERM and Paris Cite University. For the collection and biobanking of MG samples, RLP and FT acknowledge support provided by the FP6 program (MYASTAID, LSHM-CT-2006-037833), FIGHT-MG (HEALTH-2009-242-210). N.L. was supported by the Swedish Research Council (no 2021-03118) and the Goran Gustafsson Foundation (no 2141 and 2247). TLV was supported by a Poste CCA-INSERM-Bettencourt (with the support of the Fondation Bettencourt-Schueller). P.B. was supported by the French Foundation for Medical Research (FRM, EA20170638020), the MD-PhD program of the Imagine Institute (with the support of the Fondation Bettencourt-Schueller), and a Poste CCA-INSERM-Bettencourt (with the support of the Fondation Bettencourt-Schueller).

Source: 

Link: https://www.medrxiv.org/content/10.64898/2026.03.27.26349525v1

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#Clinical Features and #Management of a Critical #Human Case of #H10N3 Avian #Influenza: A Case Report and Literature Review

 

Highlights

• Nonspecific early signs hinder prompt diagnosis of H10N3 infection.

• H10N3 human infection remains rare but with high clinical severity.

• All patients had bird exposure and developed fever, cough, and dyspnoea.

• Diagnosis was confirmed by sequencing; imaging revealed viral pneumonia.

Abstract

Background

Since the first human case of H10N3 Avian Influenza in Jiangsu, China (April 2021), three cases have been reported globally. However, clinical and treatment data remain limited. Therefore, we describe the fourth patient’s epidemiology, clinical manifestations, diagnostics, treatment.

Case presentation

A 23-year-old woman, previously well, presented on 12 Dec 2024 with fever, dry cough and breathlessness after pig and chicken contact. CT showed bilateral pneumonia. Despite high-flow oxygen and broad-spectrum antibiotics she deteriorated, requiring intubation, lung-protective ventilation and VV-ECMO. Bronchoalveolar lavage isolated H10N3 influenza virus. Treatment with oseltamivir and baloxavir plus prone-position ventilation led to clinical improvement.

Conclusion

Due to its nonspecific early symptoms, H10N3 is difficult to diagnose promptly, increasing the risk. Early recognition, antiviral therapy, and aggressive support are essential in managing severe infections.

Source: 

Link: https://www.ijidonline.com/article/S1201-9712(26)00002-0/fulltext

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#Global burden of lower respiratory #infections and aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

 

Summary

Background

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years.

Methods

Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years.

Findings

In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24–2·81) deaths and 98·7 million (87·7–112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4–47·4) since 2010, with a global mortality rate of 94·8 (75·6–116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000–721 000] deaths or 25·3% [24·5–26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000–298 000] deaths or 10·9% [10·3–11·3]), and Klebsiella pneumoniae (228 000 [204 000–261 000] deaths or 9·1% [8·8–9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000–201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900–75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths.

Interpretation

This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies—including newer interventions such as respiratory syncytial virus monoclonal antibodies—and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies.

Funding

Gates Foundation.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00689-9/abstract?rss=yes

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#Hostilities in the occupied #Palestinian territory (oPt) - 11 November 2025 - Public Health #Situation #Analysis (PHSA) (#WHO, summary)

 

SUMMARY OF CRISIS AND KEY FINDINGS 

The fragile Gaza ceasefire announced on 9 October 2025 marked a momentous but precarious juncture in the ongoing conflict.{3} 

The ceasefire remains in place but is fragile, and violations from both sides continue.{4} 

When the ceasefire was agreed in mid-October, the UN Relief Chief Tom Fletcher outlined a 60-day plan to deliver vital aid to people in Gaza, stressing that full implementation requires more crossings, rapid and unimpeded access, sustained fuel entry, restored infrastructure, protection of aid workers, and adequate funding.{5}  

While humanitarian aid has begun to flow into Gaza offering a measure of relief, uncertainty persists. Meanwhile, the Rafah Crossing as well as other crossings in the north remain closed, limiting efforts to alleviate Gaza’s humanitarian crisis.{6} 

According to the Ministry of Health (MoH) in Gaza, the casualty toll among Palestinians since 7 October 2023, as reported by MoH, is 67 938 fatalities and 170 169 injuries.{7} 

Following the announcement of the ceasefire, large-scale population movements have been observed across Gaza as families attempt to return home after months of displacement. Over 533 000 people have moved from south to north since 10 October.{8} 

Most people in Gaza reside in inadequate shelters that fail to meet basic emergency standards, leaving them exposed to harsh winter conditions.{9} 

The UN Satellite Centre reported that as of 23 September, the extent of damage in Gaza City encompassed approximately 83% of all structures.{10}  

Médecins Sans Frontières (MSF) report diseases directly linked to poor living condition (such as skin infections, eye infections, aches and pains) account for 70% of all outpatient consultations in health care centres in southern Gaza.{11} 

According to Early Warning, Alert and Response System (EWARS) reporting, acute watery diarrhoea and acute respiratory infections are 17.5% of all consultations in Gaza as of October 2025.{12} 

Ongoing attacks and resource shortages have severely weakened the health system. Every hospital is overrun.{13} 

A total of 50% (18 out of 36) of hospitals are functional, all partially.{14} 

Many health facilities have been shut down in Gaza City and in the North, leaving hundreds of thousands of people with limited access to lifesaving medical services. As of 15 August 2025, Famine (IPC Phase 5)—with reasonable evidence—was confirmed in Gaza Governorate. Access constraints severely limit the quantity of aid that agencies can bring in to stabilize the markets and address people’s needs. 

Anticipation of food inflows upon the ceasefire drove food prices down. However, liquidity constraints persist, with cash withdrawal fees still between 20-24%.{15} 

While attention has been fixed on Gaza, violence and restrictions in the West Bank have intensified. Military operations in Jenin, Nur Shams, and Tulkarm refugee camps have displaced over 30 000 people, yet humanitarian groups remain barred from assessing the full scale of destruction.{16} 

More broadly, oPt has endured a protracted cycle of conflict, hunger and despair for over five decades. In 2023, this cycle reached unprecedented new peaks as tensions escalated in the occupied Gaza Strip and the West Bank on 7 October, resulting in civilian fatalities, widespread destruction, massive displacement, rising food prices and a declining currency.{17} 

The unprecedented impact of the current war on Gaza demands a transformative shift in addressing mounting immediate needs, revaluating long-term systemic challenges to relief efforts, and confronting the root causes of the conflict by ending the occupation and upholding international law.{18} 

(...)

{1} UNDSS (2024), Security Travel Advisory, available at: https://dss.un.org/Welcome-to-UNDSS?returnurl=%2f 

{2} Inform Risk Index 2025 (2024), available at: https://drmkc.jrc.ec.europa.eu/inform-index 

{3} United Nations (2025), Fragile Gaza ceasefire marks ‘a momentous but precarious juncture,’ UN envoy tells Security Council 

{4} WFP (2025), WFP Palestine’s Emergency Response External Situation Report #71 (7 November 2025) 

{5} OCHA (2025), Humanitarian Situation Update #331 | Gaza Strip [EN/AR/HE] 

{6} WFP (2025), WFP Palestine’s Emergency Response External Situation Report #71 (7 November 2025) 

{7} OCHA (2025), Humanitarian Situation Update #331 | Gaza Strip [EN/AR/HE] 

{8} WFP (2025), WFP Palestine’s Emergency Response External Situation Report #71 (7 November 2025) 

{9} UNRWA (2025), UNRWA Situation Report #192 on the Humanitarian Crisis in the Gaza Strip and the occupied West Bank, including East Jerusalem [EN/AR] 

{10} UNRWA (2025), UNRWA Situation Report #192 on the Humanitarian Crisis in the Gaza Strip and the occupied West Bank, including East Jerusalem [EN/AR] 

{11} MSF (2025), Post-ceasefire, Palestinians in Gaza are still living in dire conditions 

{12} WHO (2025) EWARS Unified Disease Surveillance Dashboard - The Gaza Strip · Dashboard · Metabase 

{13} MSF (2025), “Medicine is being strangled”: MSF doctor on the collapse of Gaza's health system 

{14} WHO (2025), HeRAMS occupied Palestinian territory: Gaza infographics September 2025 https://app.powerbi.com/view?r=eyJrIjoiZjI3ODU4N2YtZmE4Yi00NzcwLTgwMmQtN2JhOTU2YjZkNTQ1IiwidCI6ImY2MTBjMGI3LWJkMjQtN GIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9 

{15} WFP (2025), WFP reaches families most at risk with food assistance as post-ceasefire scale-up gathers pace  

{16} NRC (2025), West Bank: Impunity deepens the occupation amid increasing restrictions on aid 

{17} WFP (29 March 2024),  State of Palestine Annual Country Report 2023 - Country Strategic Plan 2018 - 2028 

{18} ESCWA (2 January 2024), October 2023 in Gaza: the deadliest month in a twenty-first century war? [EN/AR] 

(...)

Source: World Health Organization, https://cdn.who.int/media/docs/default-source/emergencies-trauma-care/who-phsa-opt-111125-final.pdf?sfvrsn=efa97590_1&download=true

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Assessment of #serum #parameters caused by the #outbreak of #mycoplasma pneumoniae #pneumonia in #children after #COVID19

Abstract

Mycoplasma pneumonia pneumonia(MPP) is a common respiratory disease that often occurs in children. The purpose of this study was to explore the clinical characteristics of children with mycoplasma pneumoniae pneumonia, the first outbreak after the prevalence of COVID-19 epidemic. Meanwhile, this study also analyzed the predictive value of serum protein indicators and coagulation parameters in the MPP group, as well as the correlation between these indicators. Children with Mycoplasma pneumoniae admitted to the pediatric ward of Chengdu Fifth People’s Hospital from May 2023 to March 2024 were selected. After screening, 411 children who met the research criteria were selected as the study subjects. All of the blood samples were tested for coagulation function, procalcitonin, serum protein and glucose among MPP group and control group. All data were processed for statistical analysis using GraphPad Prism 10.2.3. Comparison of the serum proteins and coagulation function between the MPP group and control group showed that prothrobin time(PT), thrombin time (TT), fibrinogen(Fbg), activated partial thromboplastin time (APTT), international normalized ration(INR), D-Dimer(DD) were significantly higher(P < 0.05) in MPP group. Total protein, albumin, prealbumin, alkaline phosphatase, lactate dehydrogenase, adanosine deaminase, glucose, platelet, procalcitonin also were significantly higher(P < 0.05) in MPP group. A multiple logistic regression analysis showed that the children in MPP group were a statistically significant difference in comparison of TT, Fbg, total protein, albumin, glucose, platelet expression in predicting the development. Then we analyzed the area under the ROC curve and correlation of serum parameters with significant differences in MPP group children. These results indicate that the coagulation function and serum protein of MPP patients who first broke out after the COVID-19 epidemic are different from the previous clinical characteristics, which can be used as a reference for auxiliary diagnosis.

Source: Scientific Reports, https://www.nature.com/articles/s41598-025-13555-6

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#Mycoplasma pneumoniae #Infections in Hospitalized #Children — #USA, 2018–2024

Summary

- What is already known about this topic?

-- Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in school-aged children. In the United States, M. pneumoniae infection prevalence decreased during the COVID-19 pandemic and remained low through 2023.

- What is added by this report?

-- The number of hospital discharges of children with M. pneumoniae–associated CAP from U.S. pediatric hospitals increased sharply in 2024, accounting for approximately one half of hospitalized children with CAP. This number included children aged <5 years, a group in which M. pneumoniae infections have historically been less commonly reported. Data on length of hospitalization and intensive care unit admissions indicate that M. pneumoniae infections in 2024 were not more severe than 2018–2023 infections.

- What are the implications for public health practice?

-- Increased awareness among health care providers might improve diagnosis and could guide treatment of M. pneumoniae infections among children of all ages, especially during periodic increases in M. pneumoniae circulation and among children requiring hospitalization.

Abstract

Mycoplasma pneumoniae is a common bacterial cause of respiratory infection and a leading cause of childhood community-acquired pneumonia (CAP). Increases in M. pneumoniae infection occur every 3–5 years. In the United States, M. pneumoniae prevalence decreased during and immediately after the COVID-19 pandemic. Information from 42 U.S. children’s hospitals that provided information to the Pediatric Health Information System, a database of clinical and resource use information, was used to identify discharge diagnostic codes for 2018–2024 indicating M. pneumoniae infection. M. pneumoniae–associated CAP incidence among children aged ≤18 years was significantly higher in 2024 (12.5 per 1,000 hospitalizations) than during 2018–2023 (2.1). During the study period, an M. pneumoniae diagnostic code was listed in 11.5% of pediatric CAP hospitalizations, peaking at 53.8% in July 2024. Among pediatric M. pneumoniae CAP cases, the highest percentage occurred among children aged 6–12 years (42.6%), followed by children aged 2–5 years (25.7%) and 13–18 years (21.1%). The lowest occurred among those aged 12–23 months (6.4%) and 0–11 months (4.2%). M. pneumoniae infections in 2024 were not more severe than 2018–2023 infections, as assessed by length of hospitalization and percentage of patients admitted to an intensive care unit. The increase in M. pneumoniae infections in the United States in 2024 might be higher than previous periodic increases because the susceptible population was larger after sustained low incidence during and immediately after the COVID-19 pandemic. Health care providers should be aware of the periodicity of M. pneumoniae CAP and consider testing for this pathogen as a cause of respiratory illness among children of all ages.

Source: US Centers for Disease Control and Prevention, MMWR, https://www.cdc.gov/mmwr/volumes/74/wr/mm7423a1.htm?s_cid=mm7423a1_e&ACSTrackingID=USCDC_921-DM147954&ACSTrackingLabel=Week%20in%20MMWR%3A%20Vol.%2074%2C%20June%2026%2C%202025&deliveryName=USCDC_921-DM147954

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Incidence of #healthcare-associated #infections in long-term #care #facilities in nine #European countries: a 12-month, prospective, longitudinal cohort study

Summary

Background

The number of older people in need of long-term care is increasing, and health-care-associated infections (HAIs) are a major cause of morbidity and mortality for residents of long-term care facilities (LTCFs). This study, organised by the European Centre for Disease Prevention and Control (ECDC), provided data on the incidence of HAIs and related adverse outcomes in LTCFs in European countries, supplementing the available estimates from repeated point prevalence surveys conducted by the ECDC.

Methods

In this longitudinal, prospective cohort study, we analysed all HAIs collected in a convenience sample of residents from 65 LTCFs (including general nursing homes, residential homes, and mixed facilities) in nine EU or European Economic Area (EEA) countries (Belgium, Finland, France, Italy, Lithuania, Luxembourg, the Netherlands, Poland, and Spain) over 12 months. Eligible residents were those expected to stay in the LTCF for at least the entire study period. Data were collected with three questionnaires: an institutional questionnaire, a residents' questionnaire, and an HAI questionnaire. HAIs were defined according to standard ECDC criteria. The primary outcome was HAI incidence. Incidence measures, estimated using generalised estimating equation models to account for sample heterogeneity, were percentages of each type of HAI, numbers of HAIs per 100 LTCF residents (ratio), and numbers of HAIs per 1000 resident-days (incidence rate).

Findings

HAIs were analysed in 3029 residents of LTCFs between Jan 1–May 4, 2022, and Jan 1–May 12, 2023. The mean age of study participants was 80·9 years (SD 14·6), including 960 (31·7%) men and 2069 (68·3%) women. 3763 HAIs were recorded, with at least one HAI identified in 1717 (57%) of 3029 residents. There were 124·2 HAIs (95% CI 118·6–129·9) per 100 residents and 1·8 HAIs (0·9–3·3) per 1000 resident-days. 160 (4·3% [95% CI 3·9–5·4]) HAIs led to hospitalisation, and 154 (4·5% [2·5–4·8]) were associated with death. Respiratory tract infections (RTIs) were the most frequent type of infection (n=1080, 28·9% [95% CI 27·3–30·5]), including pneumonia (n=279, 7·3% [6·4–8·3]) and other lower RTIs (n=394, 10·7% [9·6–11·8]), followed by urinary tract infections (UTIs; n=743, 18·7% [17·2–20·3]). RTIs showed the highest incidence of mortality (n=85, 2·3% [95% CI 1·8–2·8] of all HAIs). Severe cases of COVID-19 (n=72, 1·9% [95% CI 1·5–2·4] of all HAIs) were less frequent than mild or moderate cases (n=615, 16·0% [14·9–17·1] of all HAIs).

Interpretation

This study shows the high incidence of HAIs among LTCF residents in EU or EEA countries, with more than one in two residents experiencing at least one HAI, and with RTIs and UTIs accounting for almost half of all observed HAIs.

Source: Lancet Infectious Diseases, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00217-8/fulltext?rss=yes#fig1

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Post-mortem #investigation of role of endemic #human #coronaviruses in causal pathway to death amongst #children under 5 in LMIC: findings from the Child Health & Mortality Prevention Surveillance

Highlights

• Large study on the contribution of HCoV to childhood deaths

• Supports vigilance or further investigations into HCoV pathogenesis

• Potential information for the role Covid-19 will play during severe childhood disease

• Highlights the importance of polymicrobial infection during severe disease episodes

Abstract

Background

Endemic human coronaviruses (HCoV-229E, HKU1, NL63, and OC43) are common causes of mild or asymptomatic respiratory infections in children but are considered rare causes of death.

Methods

We evaluated paediatric deaths from January 2017 through December 2022. A panel of experts determined the cause of death (CoD) by reviewing available data, including pathological and molecular findings from minimally invasive tissue sampling (lung tissues, blood, CSF, and nasopharyngeal swabs), clinical records, and verbal autopsies.

Results

Endemic HCoV were detected in the respiratory samples of 3% (n=86/3357) of enrolled decedents: 1% (n=12/2043) of neonates, 5%(n=35/681) of infants and 6% (n=39/633) of children deaths. However, HCoVs were attributed as the CoD in only two cases — both involving young infants with underlying birth defects and severe wasting, who succumbed to polymicrobial hospital-acquired infections involving HCoV-OC43, Klebsiella pneumoniae, and Acinetobacter baumannii. Amongst the remaining 84 decedents in whom an HCoV was detected, 82% (n=69/84; median Ct of 25.34; range:15.28-36.17) were deaths attributed to other infections, including 54% (n=32/69; median Ct of 23.86; range:15.28-35.2) with lower respiratory infections determined to be the CoD. The bulk of these deaths (96%,n=66/69) were attributed to other pathogens - Plasmodium falciparum (27%,n=19/69), K.pneumoniae (23%,n=16/69), Streptococcus pneumoniae (20%,n=14/69), Escherichia coli (16%,n=11/69) and Cytomegalovirus (10%,n=7/69).

Conclusion

Although endemic HCoV was identified in children who died of respiratory infections, it was rarely attributed to being in the CoD. Nevertheless, further research is warranted to explore the potential role of HCoVs in LRTI pathogenesis and their impact on facilitating more pathogenic infections.

Source: Journal of Clinical Virology, https://www.sciencedirect.com/science/article/abs/pii/S1386653225000460?dgcid=rss_sd_all

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Long-Term Clinical #Outcomes of #Adults Hospitalized for #COVID19 #Pneumonia

Abstract

We conducted a multicenter, observational, 12-month follow-up study to identify the extended health burden of severe COVID-19 pneumonia by characterizing long-term sequelae of acute infection in participants previously enrolled in clinical trials for severe COVID-19 pneumonia requiring hospitalization. Overall, 134 (77.5%) of 173 participants completed the study. At 12 months, 51 (29.5%) participants reported cough, 60 (34.7%) reported dyspnea, 56 (32.4%) had residual lung texture abnormalities on high-resolution computed tomography scans, 26 (15.0%) had impaired forced vital capacity, 52 (30.1%) had cognitive impairment, and 77 (44.5%) reported fatigue. Disease severity during acute infection and age were associated with persistent lung abnormalities; history of hypertension was associated with higher prevalence of fatigue and more frequent dyspnea and cough; and age and obesity were associated with long-term cognitive impairment. Our findings underscore the long-term health burden of severe COVID-19 pneumonia, reinforcing the importance of regular monitoring in older persons and those with underlying illnesses.

Source: US Centers for Disease Control and Prevention, https://wwwnc.cdc.gov/eid/article/31/6/24-1097_article

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Increased #Pneumonia-Related #Emergency Department Visits, Northern #Italy

Abstract

An increase in pneumonia-related emergency department visits was observed in Lombardy, northern Italy, during June–October 2024. Viral causes appear insufficient to explain the increase, suggesting a bacterial cause. Mycoplasma pneumoniae and Bordetella pertussis emerged as possible causes when other surveillance systems were consulted, but the reasons behind this trend remain unknown.

Source: US Centers for Disease Control and Prevention, https://wwwnc.cdc.gov/eid/article/31/5/24-1790_article

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#Mycoplasma pneumoniae #infection in #adult inpatients during the 2023–24 #outbreak in #France (MYCADO): a national, retrospective, observational study

Summary

Background

An epidemic of Mycoplasma pneumoniae infection has been observed in France since September, 2023. We aimed to describe the characteristics of adults hospitalised for M pneumoniae infection and identify factors associated with severe outcomes of infection.

Methods

MYCADO is a retrospective observational study including adults hospitalised for 24 h or more in 76 hospitals in France for a M pneumoniae infection between Sept 1, 2023, and Feb 29, 2024. Clinical, laboratory, and imaging data were collected from medical records. We identified factors associated with severe outcomes of infection, defined as a composite of intensive care unit (ICU) admission or in-hospital death, using multivariable logistic regression.

Findings

1309 patients with M pneumoniae infection were included: 718 (54·9%) were men and 591 (45·1%) were women; median age was 43 years (IQR 31–63); 288 (22·0%) had chronic respiratory failure; 423 (32·3%) had cardiovascular comorbidities; and 105 (8·0%) had immunosuppression. The most common symptoms were cough (1098 [83·9%]), fever (1023 [78·2%]), dyspnoea (948 [72·4%]), fatigue (550 [42·0%]), expectorations (473 [36·1%]), headache (211 [16·1%]), arthromyalgia (253 [19·3%]), ear, nose, and throat symptoms (202 [15·4%]), diarrhoea (138 [10·5%]), and vomiting (132 [10·1%]). 156 (11·9%) of 1309 patients had extra-respiratory manifestations, including 36 (2·8%) with erythema multiforme, 19 (1·5%) with meningoencephalitis, 44 (3·4%) with autoimmune haemolytic anaemia, and 17 (1·3%) with myocarditis. The median hospital stay was 8 days (IQR 6–11). 424 (32·4%) patients had a severe outcome of infection, including 415 (31·7%) who were admitted to the ICU and 28 (2·1%) who died in hospital. Those more likely to present with severe outcomes of infection were patients with hypertension, obesity, chronic liver failure, extra-respiratory manifestations, pulmonary alveolar consolidation or bilateral involvement on CT scan, as well as elevated inflammatory markers, lymphopenia or neutrophilic polynucleosis, and those who did not versus did receive any antibiotic active against M pneumoniae before admission.

Interpretation

This national, observational study highlighted unexpected, atypical radiological presentations, a high proportion of transfers to the ICU, and an association between severity and delayed administration of effective antibiotics. This should remind clinicians that no radiological presentation can rule out M pneumoniae infection, and encourage them to reassess patients early after prescribing a β-lactam, or even to discuss prescribing macrolides as first-line treatment in the context of an epidemic.

Source: Lancet Infectious Diseases, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00805-3/abstract?rss=yes

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