Severe influenza: overview in critically ill patients

Purpose of review Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity. Recent findings Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival. Summary The present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.
Source: Current Opinion in Critical Care - Category: Nursing Tags: SEVERE INFECTIONS: Edited by Michael S. Niederman Source Type: research

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Innate immunity is critical in the early containment of influenza A virus (IAV) infection and surfactant protein D (SP-D) plays a crucial role in innate defense against IAV in the lungs. Multivalent lectin-mediated interactions of SP-D with IAVs result in viral aggregation, reduced epithelial infection, and enhanced IAV clearance by phagocytic cells. Previous studies showed that porcine SP-D (pSP-D) exhibits distinct antiviral activity against IAV as compared to human SP-D (hSP-D), mainly due to key residues in the lectin domain of pSP-D that contribute to its profound neutralizing activity. These observations provided the...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
The follicle-associated epithelium (FAE) is a specialized structure that samples luminal antigens and transports them into mucosa-associated lymphoid tissues (MALT). In mammals, transcytosis of antigens across the gut epithelium is performed by a subset of FAE cells known as M cells. Here we show that colony-stimulating factor 1 receptor (CSF1R) is expressed by a subset of cells in the avian bursa of Fabricius FAE. Expression was initially detected using a CSF1R-reporter transgene that also label subsets of bursal macrophages. Immunohistochemical detection using a specific monoclonal antibody confirmed abundant expression ...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
ConclusionsThe present study demonstrated that the Inula helenium and Grindelia squarrosa, which have been traditionally used in Europe as medicinal plants, are a valuable source of active compounds with anti-inflammatory activity. Our observations justify the traditional use of I. helenium and G. squarrosa for a treatment inflammation-based diseases in respiratory tract.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
DiscussionGiven the multiorgan system potential adverse side effects of prednisone, proving noninferiority of an alternate regimen would be sufficient to make the alternative compare favorably to standard dose steroids. This is the first ever clinical trial in cardiac sarcoidosis and thus in addition to the listed goals of the trial, we will also establish a multi-center, multinational cardiac sarcoidosis clinical trials network. Such a collaborative infrastructure will enable a new era of high quality data to guide physicians when treating cardiac sarcoidosis patients.
Source: American Heart Journal - Category: Cardiology Source Type: research
Conditions:   Seasonal Influenza;   Hand, Foot and Mouth Disease Interventions:   Biological: EV71 +SIV;   Biological: EV71;   Biological: SIV Sponsors:   Zhejiang Provincial Center for Disease Control and Prevention;   China National Biotec Group Company Limited Recruiting
Source: - Category: Research Source Type: clinical trials
This study provides important information for the potential utilization of nanocopper in food packaging films.Graphical abstract
Source: Food Packaging and Shelf Life - Category: Food Science Source Type: research
Source: Notes from Dr. RW - Category: Internal Medicine Tags: hospital medicine infectious disease Source Type: blogs
The incidence of chronic kidney disease (CKD) has reached pandemic proportions across the world. Critical limb ischemia (CLI) in the CKD patient is a huge clinical challenge often culminating in major amputation or mortality. Endovascular revascularization is sometimes not feasible because of potential contrast agent-induced damage to the residual renal function, whereas heavy calcification may limit the success of such interventions. Surgical revascularization in these patients also carries added challenges and risks with seemingly poor outcomes in terms of limb salvage.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
ACS Applied Materials&InterfacesDOI: 10.1021/acsami.9b15118
Source: ACS Applied Materials and Interfaces - Category: Materials Science Authors: Source Type: research
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Source: Materials Science and Engineering: C - Category: Materials Science Source Type: research
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