#Influenza-associated #pneumonia hospitalizations in #Uganda, 2013-2016 (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Influenza-associated pneumonia hospitalizations in Uganda, 2013-2016

Gideon O. Emukule , Barbara Namagambo, Nicholas Owor, Barnabas Bakamutumaho, John T. Kayiwa, Joyce Namulondo, Timothy Byaruhanga, Stefano Tempia, Sandra S. Chaves, Julius J. Lutwama

Published: July 15, 2019 / DOI: https://doi.org/10.1371/journal.pone.0219012




Influenza is an important contributor to acute respiratory illness, including pneumonia, and results in substantial morbidity and mortality globally. Understanding the local burden of influenza-associated severe disease can inform decisions on allocation of resources toward influenza control programs. Currently, there is no national influenza vaccination program in Uganda.


In this study, we used data on pneumonia hospitalizations that were collected and reported through the Health Management Information System (HMIS) of the Ministry of Health, Uganda, and the laboratory-confirmed influenza positivity data from severe acute respiratory illness (SARI) surveillance in three districts (Wakiso, Mbarara, and Tororo) to estimate the age-specific incidence of influenza-associated pneumonia hospitalizations from January 2013 through December 2016.


The overall estimated mean annual rate of pneumonia hospitalizations in the three districts was 371 (95% confidence interval [CI] 323–434) per 100,000 persons, and was highest among children aged <5 years (1,524 [95% CI 1,286–1,849]) compared to persons aged ≥5 years (123 [95% CI 105–144]) per 100,000 persons. The estimated mean annual rate of influenza-associated pneumonia hospitalization was 34 (95% CI 23–48) per 100,000 persons (116 [95% CI 78–165] and 16 [95% CI 6–28] per 100,000 persons among children aged <5 years and those ≥5 years, respectively). Among children aged <5 years, the rate of hospitalized influenza-associated pneumonia was highest among those who were <2 years old (178 [95% CI 109–265] per 100,000 persons). Over the period of analysis, the estimated mean annual number of hospitalized influenza-associated pneumonia cases in the three districts ranged between 672 and 1,436, of which over 70% represent children aged <5 years.


The burden of influenza-associated pneumonia hospitalizations was substantial in Uganda, and was highest among young children aged <5 years. Influenza vaccination may be considered, especially for very young children.


Citation: Emukule GO, Namagambo B, Owor N, Bakamutumaho B, Kayiwa JT, Namulondo J, et al. (2019) Influenza-associated pneumonia hospitalizations in Uganda, 2013-2016. PLoS ONE 14(7): e0219012. https://doi.org/10.1371/journal.pone.0219012

Editor: Ray Borrow, Public Health England, UNITED KINGDOM

Received: February 7, 2019; Accepted: June 13, 2019; Published: July 15, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the manuscript and its Supporting Information files. However, should there be need for additional data, a request can be made directly to Dr. Julius Lutwama (Program Coordinator, and Head of the Department of Arbovirology and Emerging Viral Infections at Uganda Virus Research Institute, Uganda; Email: jjlutwama03@yahoo.com).

Funding: This study was supported by U.S. Centers for Disease Control and Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Seasonal Influenza; Pneumonia; SARI; Uganda.



Serial Section Array Scanning Electron Microscopy Analysis of Cells from #Lung #Autopsy #Specimens Following #Fatal A/ #H1N1pdm09 #Influenza Virus #Infection (J Virol., abstract)

[Source: Journal of Virology, full page: (LINK). Abstract, edited.]

Serial Section Array Scanning Electron Microscopy Analysis of Cells from Lung Autopsy Specimens Following Fatal A/H1N1 2009 Pandemic Influenza Virus Infection

Michiyo Kataoka, Kinji Ishida, Katsutoshi Ogasawara, Takayuki Nozaki, Yoh-ichi Satoh, Tetsutaro Sata, Yuko Sato, Hideki Hasegawa, Noriko Nakajima

DOI: 10.1128/JVI.00644-19



A/H1N1 2009 pandemic influenza virus (A/H1N1/pdm09) was first identified as a novel pandemic influenza A virus (IAV) in 2009. Previously, we reported that many viral antigens were detected in type II alveolar epithelial cells (AEC-IIs) within autopsied lung tissue from a patient with A/H1N1/pdm09 pneumonia. It is important to identify the association between the virus and host cells to elucidate the pathogenesis of IAV pneumonia. To investigate the distribution of virus particles and morphological changes in host cells, the autopsied lung specimens from this patient were examined using transmission electron microscopy (TEM) and a novel scanning electron microscopy (SEM) method. We focused on AEC-IIs as viral antigen-positive cells, and on monocytes/macrophages (Ms/MΦs) and neutrophils (Neus) as innate immune cells. We identified virus particles and intranuclear dense tubules, which are associated with matrix 1 (M1) proteins from IAV. Large-scale two-dimensional observation was enabled by digitally ‘stitching’ together contiguous SEM images. A single whole cell analysis using a serial section array (SSA)-SEM identified virus particles in vesicles within the cytoplasm and/or around the cell surface of AEC-IIs, Ms/MΦs, and Neus; however, intranuclear dense tubules were found only in AEC-IIs. Computer-assisted processing of SSA-SEM images from each cell type enabled 3D modeling of the distribution of virus particles within an ACE-II, a M/MΦ, and a Neu.



Generally, it is difficult to observe IAV particles in post-mortem samples from patients with seasonal influenza. In fact, only a few viral antigens are detected in bronchial epithelial cells from autopsied lung sections. Previously, we detected many viral antigens in AEC-IIs from the lung. This was because the majority of A/H1N1/pdm09 in the lung tissue harbored an aspartic acid to glycine substitution at position 222 (D222G) of the hemagglutinin protein. A/H1N1/pdm09 harboring the D222G substitution has a receptor-binding preference for α-2,3-linked sialic acids expressed on human AECs and infects them in the same way as H5N1 and H7N9 avian IAVs. Here, we report the first successful observation of virus particles not only in AEC-IIs, but also in Ms/MΦs and Neus, using electron microscopy. The finding of a M/MΦ harboring numerous virus particles within vesicles and at the cell surface suggests that Ms/MΦs are involved in the pathogenesis of IAV primary pneumonia.

Copyright © 2019 Kataoka et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Influenza A; Seasonal Influenza; Pandemic Influenza; Avian Influenza; H1N1pdm09; H5N1; H7N9; Viral pathogenesis.


#Clinical #manifestations and #outcomes of #RSV #infection in #adult hospitalized patients (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 3 July 2019 / In Press, Accepted Manuscript

Clinical manifestations and outcomes of respiratory syncytial virus infection in adult hospitalized patients

Benjamas Chuaychoo a, Sopita Ngamwongwan a,b, Bualan Kaewnaphan c, Niracha Athipanyasilp c, Navin Horthongkham c, Wannee Kantakamalakul c, Nisa Muangman d

{a} Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; {b} Division of Respiratory Disease, Department of Medicine, Faculty of Medicine, Chonburi hospital, Chonburi, Thailand; {c} Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; {d} Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Received 2 January 2019, Revised 25 May 2019, Accepted 2 July 2019, Available online 3 July 2019. DOI: https://doi.org/10.1016/j.jcv.2019.07.001



  • Adult hospitalized patients with RSV were advanced age and had comorbidities.
  • Cardiopulmonary complications were common.
  • Major complication was pneumonia with acute respiratory failure.
  • Pre-existing coronary arterial disease was a risk factor of cardiovascular complication.
  • Pneumonia and acute myocardial infarction were the major causes of death.




Respiratory syncytial virus (RSV) is an important virus found in adult hospitalized patients.


To study the clinical outcomes of hospitalized patients aged ≥ 15 years and diagnosed with RSV infection.

Study design

Both retrospective and prospective cohort studies were conducted at a university hospital between May 2014 and December 2015.


RSV was detected in 86 of 1562(5.5%) adult hospitalized patients suspected of respiratory viral infection. Sixty-nine patients were included in the study. RSV was detected by RT-PCR (82.6%), IFA (10.1%), and both RT-PCR and IFA (7.3%). Most patients (87.0%) were aged ≥ 50 years. Cardiovascular diseases, pulmonary diseases, immunocompromised hosts, and diabetes were the major comorbidities. The common manifestations were cough (92.8%), dyspnea (91.3%), sputum production (87.0%), tachypnea (75.4%), wheezing (73.9%), and fever (71.0%). Fifty- five patients (79.7%) were diagnosed with pneumonia. Hypoxemia (SpO2 ≤ 92%) was found in 53.6 % patients. Twenty-five of 69(36.2%) patients developed respiratory failure and required ventilatory support. Cardiovascular complications were found in 24.6% of patients. Congestive heart failure, acute myocardial infarction (MI), new atrial fibrillation, and supraventricular tachycardia were found in 9(13.0%), 7(10.1%), 4(5.8%), and 3(4.3%) of 69 patients, respectively. Overall mortality was 15.9%. Pneumonia (81.8%) and acute MI (18.2%) were the major causes of death.


Most adult hospitalized patients with RSV infection were of advanced age and had comorbidities. Cardiopulmonary complications were the major causes of death. Management and prevention of RSV infection in these vulnerable groups are necessary.

Keywords: RSV – adult – hospitalization – cardiovascular disease – pneumonia – respiratory failure

© 2019 Published by Elsevier B.V.

Keywords: RSV; Pneumonia.


Causes of severe #pneumonia requiring #hospital admission in #children without HIV infection from #Africa and #Asia: the #PERCH multi-country case-control study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study

The Pneumonia Etiology Research for Child Health (PERCH) Study Group †

Open Access / Published: June 27, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30721-4




Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings.


We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1–59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data.


Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6–97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3–65·6) of causes, whereas bacteria accounted for 27·3% (23·3–31·6) and Mycobacterium tuberculosis for 5·9% (3·9–8·3). Viruses were less common (54·5%, 95% CrI 47·4–61·5 vs 68·0%, 62·7–72·7) and bacteria more common (33·7%, 27·2–40·8 vs 22·8%, 18·3–27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4–34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus–enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site’s aetiological fraction.


In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes.


Bill & Melinda Gates Foundation.

Keywords: Pneumonia; Pediatrics; Africa; Asia; Streptococcus pneumoniae; RSV; Metapneumovirus; Seasonal Influenza.


#Pediatric #viral #orbital #cellulites secondary to #H1N1 infection: A case report (Indian J Ophthalmol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Indian J Ophthalmol. 2019 Jul;67(7):1234-1235. doi: 10.4103/ijo.IJO_1549_18.

Pediatric viral orbital cellulites secondary to H1N1 infection: A case report.

Smitha KS1, Deshmukh AV1, Manjandavida FP1, Babu K1.

Author information: 1 Prabha Eye Clinic and Research Centre and Vittala International Institute of Ophthalmology, Bangalore, Karnataka, India.



A 10-year-old boy admitted for high-grade fever and pneumonia developed left preseptal and early orbital cellulitis, unresponsive to higher intravenous antibiotics. He received oseltamivir, on testing positive for H1N1 virus on the nasopharyngeal and throat swabs. There was dramatic improvement with resolution of orbital cellulitis within 24 h of starting oseltamivir. We report a very rare presentation of pediatric orbital cellulitis secondary to systemic H1N1 infection. Prompt investigations and timely treatment with oseltamivir aided in complete resolution, avoiding vision and life-threatening complications.

KEYWORDS: H1N1; orbital cellulites; oseltamivir; preseptal; swine flu

PMID: 31238479 DOI: 10.4103/ijo.IJO_1549_18

Keywords: Seasonal Influenza; H1N1pdm09; Pneumonia; Ophthalmology.


#Simvastatin Improves #Neutrophil Function and Clinical #Outcomes in #Pneumonia: a Pilot #RCT (Am J Respir Crit Care Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Respir Crit Care Med. 2019 Jun 17. doi: 10.1164/rccm.201812-2328OC. [Epub ahead of print]

Simvastatin Improves Neutrophil Function and Clinical Outcomes in Pneumonia: a Pilot Randomised Controlled Trial.

Sapey E1, Patel JM2, Greenwood H3, Walton GM4, Grudzinska F4, Parekh D5, Mahida RY2, Dancer RC3, Lugg ST4, Howells PA6, Hazeldine J2, Newby P4, Scott A3, Nightingale P7, Hill AT8, Thickett DR9.

Author information: 1 University of Birmingham, Institute of Inflammation and Ageing, Birmingham, United Kingdom of Great Britain and Northern Ireland ; e.sapey@bham.ac.uk. 2 University of Birmingham, 1724, Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom of Great Britain and Northern Ireland. 3 University of Birmingham, Institute of Inflammation and Aging, Birmingham, United Kingdom of Great Britain and Northern Ireland. 4 University of Birmingham, Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom of Great Britain and Northern Ireland. 5 University of Birmingham, Critical Care and Pain Perioperative, Critical Care and Trauma Trials Group, School of Clinical and Experimental Medicine,, Birmingham, United Kingdom of Great Britain and Northern Ireland. 6 University of Birmingham, Centre for Translational Inflammation Research, Birmingham, United Kingdom of Great Britain and Northern Ireland. 7 University Hospital Birmingham NHS Foundation Trust, Statistics, Birmingham, United Kingdom of Great Britain and Northern Ireland. 8 Royal Infirmary of Edinburgh, Respiratory Medicine, Scotland, Edinburgh, United Kingdom of Great Britain and Northern Ireland. 9 University of Birmingham, Lung Injury and Fibrosis Treatment Programme, Birmingham, United Kingdom of Great Britain and Northern Ireland.




Population studies suggest improved sepsis outcomes with statins but randomized controlled trials in patients with sepsis and organ dysfunction in critical care settings have broadly been negative. In vitro data suggest statins modulate age-related neutrophil functions improving neutrophil responses to infection, but only in older patients and at high dose.


To determine if high dose simvastatin improved neutrophil functions and clinical outcomes in hospitalized older adults with community acquired pneumonia with sepsis (CAP+S) not admitted to critical care.


A randomized, double-blinded, placebo-controlled pilot study of simvastatin 80mg or placebo for 7 days for CAP+S patients aged >55 years admitted to a secondary care hospital. Day 4 primary endpoint was change in neutrophil NETosis. Day 4 secondary endpoints included neutrophil chemotaxis, safety and tolerability, Sequential Organ Failure Assessment(SOFA) score, mortality, readmission and markers of tissue degradation/inflammation.


Four days of simvastatin adjuvant therapy in CAP+S was associated with improvements in systemic neutrophil function (NETosis and chemotaxis), a reduction in systemic neutrophil elastase burden and improved SOFA scores compared with placebo. A post-hoc analysis demonstrated simvastatin therapy was associated with improved hospital-free survival compared to placebo. Simvastatin was well tolerated in this elderly and multi-morbid patient group with common co-prescription of macrolide antibiotics.


This pilot study supports high-dose simvastatin as an adjuvant therapy in CAP+S in an older and milder disease cohort than assessed previously. A definitive multi-centred study is now warranted in this population to assess the likelihood of benefit and harm. Clinical trial registration available at clinicaltrialsregister.eu/ctr-search/search, ID: 2012-003343-29.

KEYWORDS: elderly care; innate immunity; pneumonia; sepsis; statin

PMID: 31206313 DOI: 10.1164/rccm.201812-2328OC

Keywords: Pneumonia; Sepsis; Statins.


A Retrospective Analysis of Three #Antiviral Regimens of #Peramivir in the Treatment of Severe #Influenza A with Primary Viral #Pneumonia (Can Respir J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Can Respir J. 2019 Apr 30;2019:3859230. doi: 10.1155/2019/3859230. eCollection 2019.

A Retrospective Analysis of Three Antiviral Regimens of Peramivir in the Treatment of Severe Influenza A with Primary Viral Pneumonia.

Wang JN1, Wang X1, Yu SL1, Ding YH1, Wang ML1, Chen HD1.

Author information: 1 Department of Pharmacy, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, China.




To evaluate the difference of clinical efficacy of peramivir alone and peramivir combined with immunomodulators (either ribonucleic acid or thymopetidum) in the treatment of severe influenza A with primary viral pneumonia.


A retrospective analysis was applied to 45 patients who were diagnosed with severe influenza A with primary viral pneumonia in our hospital from December 2017 to March 2018. The cases were divided into three groups: the peramivir group, the peramivir combined with ribonucleic acid group, and the peramivir combined with thymopetidum group.


The duration of viral nucleic acid positivity in the peramivir group, the peramivir combined with ribonucleic acid group, and the peramivir combined with thymopetidum group was 6.13 ± 2.06, 6.53 ± 2.72, and 6.10 ± 1.37 days, respectively. The remission time of the clinical symptoms of the peramivir group, the peramivir combined with ribonucleic acid group, and the peramivir combined with thymopetidum group was 8.06 ± 2.73, 7.94 ± 2.89, and 7.67 ± 1.58 days, respectively. Comparisons between the peramivir group and the peramivir combined with ribonucleic acid group or the peramivir combined with thymopetidum group revealed no significant differences in the duration of virus nucleic acid positivity, remission time of clinical symptoms, time to fever alleviation, and time to cough alleviation.


There is no observed benefit in the addition of ribonucleic acid or thymopetidum when peramivir sodium chloride injection is used in the treatment of severe influenza A with primary viral pneumonia. This trial is registered with ChiCTR1800019417.

PMID: 31182983 PMCID: PMC6515146 DOI: 10.1155/2019/3859230

Keywords: Influenza A; Antivirals; Peramivir; Pneumonia.