#Oseltamivir #resistance in #severe #influenza A #H1N1pdm09 #pneumonia and #ARDS: a #French multicenter observational cohort study (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 Sep 20. pii: ciz904. doi: 10.1093/cid/ciz904. [Epub ahead of print]

Oseltamivir resistance in severe influenza A(H1N1)pdm09 pneumonia and acute respiratory distress syndrome: a French multicenter observational cohort study.

Behillil S1, May F2,3, Fourati S4, Luyt CE5, Chicheportiche T5, Sonneville R6, Tandjaoui-Lambiotte Y7, Roux D8, Guérin L9, Mayaux J10, Maury E11, Ferré A12, Georger JF13, Voiriot G14, Enouf V1, van der Werf S1, Dessap AM2,3, de Prost N2,3.

Author information: 1 Unité de Génétique Moléculaire des Virus à ARN et Centre National de Référence des Virus des Infections Respiratoires (dont la grippe), Institut Pasteur, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 2 Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France. 3 Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil,  France. 4 Département de Microbiologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France. 5 Service de Médecine Intensive Réanimation, Hôpital de La Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France. 6 Service de Médecine Intensive Réanimation, Hôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France. 7 Service de Réanimation médico-chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France. 8 Service de réanimation médico-chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes,  France; IAME, Université Paris Diderot, Paris, France. 9 Service de réanimation médicale, Hôpital Bicètre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicètre, France. 10 Service de Réanimation Médicale et Pneumologie, Hôpital de La Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France. 11 Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. 12 Service de Réanimation, Centre hospitalier de Versailles, Le Chesnay, France. 13 Service de Réanimation, Centre hospitalier Intercommunal de Villeneuve Saint-Georges, Villeneuve Saint-Georges, France. 14 Service de Réanimation Médicale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.



In a multicenter cohort study including 22 oseltamivir-treated patients with influenza A(H1N1)pdm09 acute respiratory distress syndrome, prevalence of the H275Y substitution in the neuraminidase, responsible for highly reduced sensitivity to oseltamivir, was 23%. Patients infected with the H275Y mutant virus had higher day-28 mortality than others (80% vs 12%; p=0.011).

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

KEYWORDS: Influenza A Virus, H1N1 Subtype; Oseltamivir; Pneumonia, Viral; Respiratory Distress Syndrome, Adult

PMID: 31538643 DOI: 10.1093/cid/ciz904

Keywords: Seasonal Influenza; H1N1pdm09; Antivirals; Drugs Resistance; Oseltamivir; Pneumonia; ARDS; France.



#Mycoplasma pneumoniae #Carriage With De Novo #Macrolide #Resistance and Breakthrough #Pneumonia (Pediatrics, abstract)

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

Pediatrics. 2019 Sep 5. pii: e20191642. doi: 10.1542/peds.2019-1642. [Epub ahead of print]

Mycoplasma pneumoniae Carriage With De Novo Macrolide-Resistance and Breakthrough Pneumonia.

Alishlash AS1, Atkinson TP2, Schlappi C2, Leal SM Jr3, Waites KB3, Xiao L4.

Author information: 1 Departments of Pediatrics, ammarsaadoon@uabmc.edu. 2 Departments of Pediatrics. 3 Pathology, and. 4 Medicine, University of Alabama at Birmingham, Birmingham, Alabama.



Mycoplasma pneumoniae pneumonia is prevalent in children and can be followed by upper airway carriage for months. Treatment of M pneumoniae pneumonia with macrolides is widespread and can lead to the development of macrolide resistance. The clinical consequences of chronic M pneumoniae carriage are unknown. In this article, we describe a child with acute lymphoblastic leukemia who developed macrolide-susceptible M pneumoniae pneumonia confirmed by nasopharyngeal secretions polymerase chain reaction and culture with good response to azithromycin. Five months later, the patient developed another M pneumoniae pneumonia that was diagnosed with positive macrolide-resistant M pneumoniae polymerase chain reaction and culture from the bronchoalveolar lavage. The child responded well to fluoroquinolones and eventually was discharged from the hospital. The M pneumoniae recovered from the second pneumonia is a novel strain and is genetically identical to the M pneumoniae that caused the first pneumonia, apart from the macrolide-resistance 23S ribosomal RNA gene. Both isolates are identical in both P1 (subtype 2 with a novel variant, 2bv) and multiple-locus variable number tandem repeat analysis type (53662). This is indicative of chronic M pneumoniae carriage with de novo macrolide-resistance mutation and subsequent breakthrough pneumonia that is reported for the first time here. Children with immunosuppression may be at increased risk of life-threatening macrolide-resistant pneumonia after M pneumoniae carriage. Further studies are required to evaluate the impact of this phenomenon. This will then guide strategies to limit the associated morbidity, such as testing for macrolide resistance, treatment of M pneumoniae pneumonia in high-risk children with bactericidal antibiotics (such as fluoroquinolones), and possibly eradication protocols of M pneumoniae carriage to prevent subsequent life-threatening infections.

Copyright © 2019 by the American Academy of Pediatrics.

PMID: 31488697 DOI: 10.1542/peds.2019-1642

Keywords: Antibiotics; Drugs Resistance; Mycoplasma pneumoniae; Macrolides; Pneumonia; USA.


#Pulmonary #Illness Related to #ECigarette Use in #Illinois and #Wisconsin — Preliminary #Report (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

Jennifer E. Layden, M.D., Ph.D., Isaac Ghinai, M.B., B.S., Ian Pray, Ph.D., Anne Kimball, M.D., Mark Layer, M.D., Mark Tenforde, M.D., Ph.D., Livia Navon, M.S., Brooke Hoots, Ph.D., Phillip P. Salvatore, Ph.D., Megan Elderbrook, M.P.H., Thomas Haupt, M.S., Jeffrey Kanne, M.D., et al.




E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation.


We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools.


There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.


Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

Keywords: Pneumonia; Undiagnosed illness; Toxic chemicals; USA; Illinois; Wisconsin.


#Staphylococcus aureus from #hospital-acquired #pneumonia from an #Italian nationwide #survey: activity of #ceftobiprole …, & molecular epidemiology of methicillin-resistant isolates (J Antimicrob Chemother., abstract)

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

Staphylococcus aureus from hospital-acquired pneumonia from an Italian nationwide survey: activity of ceftobiprole and other anti-staphylococcal agents, and molecular epidemiology of methicillin-resistant isolates

Alberto Antonelli, Tommaso Giani, Marco Coppi, Vincenzo Di Pilato, Fabio Arena, Olga Lorenza Colavecchio, Viola Conte, Anne Santerre Henriksen, Gian Maria Rossolini, MRSA-HAP Study Group

Journal of Antimicrobial Chemotherapy, dkz371, https://doi.org/10.1093/jac/dkz371

Published: 06 September 2019




To determine the prevalence of Staphylococcus aureus from hospital-acquired pneumonia (HAP) in Italy and the susceptibility to ceftobiprole and comparators of MSSA and MRSA isolates. A secondary objective was to characterize the clonality and acquired resistance and virulence genes of MRSA.


Consecutive non-replicate isolates from HAP were collected from 13 laboratories distributed across Italy, from January to May 2016. Antimicrobial susceptibility testing was performed by broth microdilution, and results were interpreted according to the EUCAST breakpoints. All MRSA isolates were subjected to WGS using an Illumina platform. Clonality and resistance and virulence gene content were investigated with bioinformatics tools.


Among 333 isolates from HAP, S. aureus was the third most common pathogen (18.6%). The proportion of MRSA was 40.3%. Susceptibility to ceftobiprole was 100% for MSSA and 95.5% for MRSA. Lower susceptibility rates of 78.4% and 94.6% in MSSA and 36.4% and 12.1% in MRSA isolates were observed for erythromycin and levofloxacin, respectively. The MRSA from HAP mostly belonged to clonal complex (CC) 22 (47.0%), CC5 (25.8%) and CC8 (15.2%), with a minority of other lineages (ST1, ST6, ST7, ST30, ST152 and ST398). Acquired resistance and virulence genes in most cases exhibited a clonal distribution. The three ceftobiprole-resistant isolates exhibited an MIC of 4 mg/L and belonged to ST228-MRSA-I of CC5.


S. aureus is an important cause of HAP in Italy. Ceftobiprole exhibited good in vitro activity against S. aureus isolated from HAP, including MRSA. A trend to replacement of ST228 with ST22 was noticed compared with previous studies.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Staphylococcus aureus; MRSA; Pneumonia; Nosocomial outbreaks; Italy.


#Pulmonary Involvement during the #Ebola Virus Disease (Viruses, abstract)

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

Viruses. 2019 Aug 24;11(9). pii: E780. doi: 10.3390/v11090780.

Pulmonary Involvement during the Ebola Virus Disease.

Lalle E1, Biava M1, Nicastri E1, Colavita F1, Di Caro A1,2, Vairo F1,2, Lanini S1, Castilletti C1, Langer M3, Zumla A4,5, Kobinger G6,7,8, Capobianchi MR1, Ippolito G9,10.

Author information: 1 National Institute for Infectious Diseases ‘Lazzaro Spallanzani’ IRCCS, 00149 Rome, Italy. 2 International Public Health Crisis Group, 00149 Rome, Italy. 3 EMERGENCY Onlus NGO, Via Santa Croce 19, 20122 Milan, Italy. 4 International Public Health Crisis Group, London WC1E 6BT, UK. 5 Division of Infection and Immunity, National Institute for Health Research Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, London WC1E 6BT, UK. 6 International Public Health Crisis Group, Quebec City, PQ G1V 0A6, Canada. 7 Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada. 8 Département de microbiologie-infectiologie et d’immunologie, Université Laval, Québec, PQ G1V 0A6, Canada. 9 National Institute for Infectious Diseases ‘Lazzaro Spallanzani’ IRCCS, 00149 Rome, Italy. giuseppe.ippolito@inmi.it. 10 International Public Health Crisis Group, 00149 Rome, Italy. giuseppe.ippolito@inmi.it.



Filoviruses have become a worldwide public health concern, especially during the 2013-2016 Western Africa Ebola virus disease (EVD) outbreak-the largest outbreak, both by number of cases and geographical extension, recorded so far in medical history. EVD is associated with pathologies in several organs, including the liver, kidney, and lung. During the 2013-2016 Western Africa outbreak, Ebola virus (EBOV) was detected in the lung of infected patients suggesting a role in lung pathogenesis. However, little is known about lung pathogenesis and the controversial issue of aerosol transmission in EVD. This review highlights the pulmonary involvement in EVD, with a special focus on the new data emerging from the 2013-2016 Ebola outbreak.

KEYWORDS: Ebola virus; Ebola virus disease; lung pathogenesis; respiratory disease

PMID: 31450596 DOI: 10.3390/v11090780

Keywords: Ebola; Pneumonia.


Efficacy of Active #Immunization with Attenuated Alpha-Hemolysin and PVL in a Rabbit Model of #Staphylococcus aureus Necrotizing #Pneumonia (J Infect Dis., abstract)

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

Efficacy of Active Immunization with Attenuated Alpha-Hemolysin and Panton-Valentine Leukocidin in a Rabbit Model of Staphylococcus aureus Necrotizing Pneumonia

Vuvi G Tran, Arundhathi Venkatasubramaniam, Rajan P Adhikari,Subramaniam Krishnan, Xing Wang, Vien T M Le, Hoan N Le, Trang T T Vu,Erika Schneider-Smith, M Javad Aman, Binh An Diep

The Journal of Infectious Diseases, jiz437, https://doi.org/10.1093/infdis/jiz437

Published: 26 August 2019



Staphylococcus aureus is a common pathogen causing infections in humans with various degrees of severity, with pneumonia being one of the most severe infections. In as much as staphylococcal pneumonia is a disease driven in large part by alpha-hemolysin (Hla) and Panton-Valentine leukocidin (PVL), we evaluated whether active immunization with attenuated forms of Hla (HlaH35L/H48L) alone, PVL components (LukS-PVT28F/K97A/S209A and LukF-PVK102A) alone, or combination of all three toxoids could prevent lethal challenge in a rabbit model of necrotizing pneumonia caused by the USA300 community-associated methicillin-resistant S. aureus. Rabbits vaccinated with Hla toxoid alone or PVL components alone were only partially protected against lethal pneumonia, whereas those vaccinated with all three toxoids had 100% protection against lethality. Vaccine-mediated protection correlated with induction of polyclonal antibody response that neutralized not only alpha-hemolysin and PVL, but also other related toxins, produced by USA300 and other epidemic MRSA clones.

MRSA, pneumonia, alpha-toxin, PVL, antibodies, vaccine

Topic: staphylococcus aureus – immunization, active – human leukocyte antigens – clone cells – hemolysin – methicillin – pneumonia – staphylococcal pneumonia – oryctolagus cuniculus – toxins – toxoids – vaccination – vaccines – infection – antibodies – polyclonal antibody – pathogenic organism – pneumonia, necrotizing – epidemics – methicillin-resistant staphylococcus aureus – pathogenicity – alpha-toxin – panton-valentine leukocidin – community – methicillin-resistant staphylococcal aureus pneumonia – attenuation

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Staphylococcus aureus; MRSA; Pneumonia; Vaccines; Animal models.


#Clinical #epidemiology and #mortality on patients with acute respiratory distress syndrome (#ARDS) in #Vietnam (PLoS One, abstract)

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


Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam

Luong Quoc Chinh, Toshie Manabe , Do Ngoc Son, Nguyen Van Chi, Yuji Fujikura, Nguyen Gia Binh, Dao Xuan Co, Dang Quoc Tuan, Mai Duy Ton, Khuong Quoc Dai, Pham The Thach, Hiroyuki Nagase, Koichiro Kudo, Dat Anh Nguyen


Published: August 15, 2019 / DOI: https://doi.org/10.1371/journal.pone.0221114




The clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam.


We conducted a retrospective observational study at a national tertiary hospital in Hanoi, Vietnam. Participants were adult patients (age ≥18 years) who were admitted and diagnosed with ARDS during 2015–2017. Data on patients’ general and clinical conditions, radiographic findings, ventilator settings, gas exchange, and treatment methods were collected and compared between survivors and non-survivors. Risk factors for mortality were assessed using logistic regression analysis.


Among 126 eligible patients with ARDS admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%). Of the total patients, 91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and then diagnosed with ARDS at the central hospital. At the time of admission, 53.2% of patients had severe ARDS, 37.3% had moderate ARDS, and 9.5% had mild ARDS. The mean (standard deviation) sequential organ failure assessment (SOFA) score was 9.5 (3.4) in non-survivors and 7.4 (3.4) in survivors (p = 0.002). Although there was no significant difference in PaO2/FiO2 on admission between non-survivors and survivors, that on day 3 after admission was significantly different (p = 0.002). Logistic regression revealed that PaO2/FiO2 on day 3 [odds ratio (OR), 1.010; 95% confidence interval (CI), 1.003–1.017], length of stay in a local hospital before admission to the central hospital (OR, 1.122; 95% CI, 1.042–1.210) due to stable condition, and SOFA score on Day 1 (OR, 0.842; 95% CI, 0.708–1.002) were independent factors in patient survival.


Patients with ARDS admitted the central tertiary hospital had severe illness and high mortality. Most patients were transferred from local hospitals. Improvements in human, medical, and sociological resources in local will contribute to reducing the mortality of ARDS in Vietnam.


Citation: Chinh LQ, Manabe T, Son DN, Chi NV, Fujikura Y, Binh NG, et al. (2019) Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam. PLoS ONE 14(8): e0221114. https://doi.org/10.1371/journal.pone.0221114

Editor: Andrea Coppadoro, San Gerardo Hospital, ITALY

Received: March 24, 2019; Accepted: July 30, 2019; Published: August 15, 2019

Copyright: © 2019 Chinh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This study was supported by the Japan Society for the Promotion of Science (JSPS) grant KAKENHI26293115. The funder 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: ARDS; Pneumonia; Intensive Care; Vietnam.