Advertisement

Infection

, Volume 47, Issue 3, pp 425–433 | Cite as

Analysis of acute respiratory infections due to influenza virus A, B and RSV during an influenza epidemic 2018

  • Spiridon Topoulos
  • Christian Giesa
  • Sören Gatermann
  • Rene Fussen
  • Sebastian Lemmen
  • Santiago EwigEmail author
Original Paper
  • 328 Downloads

Abstract

Purpose

We studied the incidence, morbidity and mortality of all patients presenting in our teaching hospital with proven influenza virus and/or respiratory syncytial virus (RSV) infection during the influenza epidemic season 2018 which was characterized by a predominant incidence of influenza virus B type B of the Yamagata line.

Methods

In the fall of 2017, specific precaution measures in addition to standard measures were implemented, including standardized testing for influenza virus A,B and RSV by multiplex PCR of pharyngeal swabsData from all consecutive patients were analyzed retrospectively.

Results

Overall 651 patients were examined for the presence of influenza virus and RSV; 214 patients had influenza virus A (n = 36), B (n = 152), and/or RSV (n = 30), including four patients with dual infection. 86% of cases had influenza virus (80% B), and 14% RSV infection. N = 23 cases were treated as outpatients. The rate of acute viral respiratory infections (influenza virus and RSV) was 191 of 2776 (6.9%) admissions to medical wards. Of n = 191 hospitalized cases, n = 44 cases (20.6%) had nosocomial infection. Viral infections were associated with a high morbidity (pneumonia 28.5%, mortality 4.7%). Independent predictors of prolonged hospitalization were the presence of pneumonia, NIV and renal complications, and independent predictors of pneumonia were age ≥ 65 years, bedridden status and CRP ≥ 2.9 mg/dL.

Conclusions

The rate of nosocomial cases was high despite established precaution measures. RSV was associated with morbidity and mortality comparable to influenza. Pneumonia remains the main complication of acute viral respiratory infections, and antimicrobial treatment should include both antiviral as well as antibacterial agents.

Keywords

Influenza epidemic Viral respiratory tract infection Coinfection Pneumonia 

Abbreviations

NIV

Noninvasive mechanical ventilation

MV

(Invasive) mechanical ventilation

Notes

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
  2. 2.
  3. 3.
    Branche AR, Falsey AR. Respiratory syncytial virus infection in older adults: an under-recognized problem. Drugs Aging. 2015;32:261–9.CrossRefGoogle Scholar
  4. 4.
    Binder W, Thorsen J, Borczuk P. RSV in adult ED patients: do emergency providers consider RSV as an admission diagnosis? Am J Emerg Med. 2017;35:1162–5.CrossRefGoogle Scholar
  5. 5.
    Lee N, Lui GC, Wong KT, Li TC, Tse EC, Chan JY, Yu J, Wong SS, Choi KW, Wong RY, Ngai KL, Hui DS, Chan PK. High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis. 2013;57:1069–77.CrossRefGoogle Scholar
  6. 6.
    Falsey AR, McElhaney JE, Beran J, van Essen GA, Duval X, Esen M, Galtier F, Gervais P, Hwang SJ, Kremsner P, Launay O, Leroux-Roels G, McNeil SA, Nowakowski A, Richardus JH, Ruiz-Palacios G, St Rose S, Devaster JM, Oostvogels L, Durviaux S, Taylor S. Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness. J Infect Dis. 2014;209:1873–81.CrossRefGoogle Scholar
  7. 7.
    Loubet P, Lenzi N, Valette M, Foulongne V, Krivine A, Houhou N, Lagathu G, Rogez S, Alain S, Duval X, Galtier F, Postil D, Tattevin P, Vanhems P, Carrat F, Lina B, Launay O, FLUVAC Study Group. Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France. Clin Microbiol Infect. 2017;23:253–9.CrossRefGoogle Scholar
  8. 8.
    Saxena S, Singh D, Zia A, Umrao J, Srivastava N, Pandey A, Singh S, Bhattacharya P, Kumari R, Kushwaha R, Dhole TN. Clinical characterization of influenza A and human respiratory syncytial virus among patients with influenza like illness. J Med Virol. 2017;89:49–54.CrossRefGoogle Scholar
  9. 9.
    Volling C, Hassan K, Mazzulli T, Green K, Al-Den A, Hunter P, Mangat R, Ng J, McGeer A. Respiratory syncytial virus infection-associated hospitalization in adults: a retrospective cohort study. BMC Infect Dis. 2014;14:665.CrossRefGoogle Scholar
  10. 10.
    Jansen AG, Sanders EA, Hoes AW, van Loon AM, Hak E. Influenza- and respiratory syncytial virus-associated mortality and hospitalisations. Eur Respir J. 2007;30:1158–66.CrossRefGoogle Scholar
  11. 11.
    Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, Shinde V. Estimates of mortality attributable to influenza and RSV in the United States during 1997–2009 by influenza type or subtype, age, cause of death, and risk status. Influenza Other Respir Viruses. 2014;8:507–15.CrossRefGoogle Scholar
  12. 12.
    Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, Shinde V. Estimates of hospitalization attributable to influenza and RSV in the US during 1997–2009, by age and risk status. BMC Public Health. 2017;17:271.CrossRefGoogle Scholar
  13. 13.
    Malosh RE, Martin ET, Callear AP, Petrie JG, Lauring AS, Lamerato L, Fry AM, Ferdinands J, Flannery B, Monto AS. Respiratory syncytial virus hospitalization in middle-aged and older adults. J Clin Virol. 2017;96:37–43.CrossRefGoogle Scholar
  14. 14.
    Kwon YS, Park SH, Kim MA, Kim HJ, Park JS, Lee MY, Lee CW, Dauti S, Choi WI. Risk of mortality associated with respiratory syncytial virus and influenza infection in adults. BMC Infect Dis. 2017;17:785.CrossRefGoogle Scholar
  15. 15.
    Fleming DM, Cross KW. Respiratory syncytial virus or influenza? Lancet. 1993;342:1507–1510.CrossRefGoogle Scholar
  16. 16.
    Hagel S, Ludewig K, Moeser A, Baier M, Löffler B, Schleenvoigt B, Forstner C, Pletz MW. Characteristics and management of patients with influenza in a German hospital during the 2014/2015 influenza season. Infection. 2016;44:667–72.CrossRefGoogle Scholar
  17. 17.
    Jensen TO, Stelzer-Braid S, Willenborg C, Cheung C, Andresen D, Rawlinson W, Clezy K. Outbreak of respiratory syncytial virus (RSV) infection in immunocompromised adults on a hematology ward. J Med Virol. 2016;88:1827–31.CrossRefGoogle Scholar
  18. 18.
    Nabeya D, Kinjo T, Parrott GL, Uehara A, Motooka D, Nakamura S, Nahar S, Nakachi S, Nakamatsu M, Maeshiro S, Haranaga S, Tateyama M, Tomoyose T, Masuzaki H, Horii T, Fujita J. The clinical and phylogenetic investigation for a nosocomial outbreak of respiratory syncytial virus infection in an adult hemato-oncology unit. J Med Virol. 2017;89:1364–1137.CrossRefGoogle Scholar
  19. 19.
    Martin-Loeches I, van Someren Gréve F, Schultz MJ. Bacterial pneumonia as an influenza complication. Curr Opin Infect Dis. 2017;30:201–20.CrossRefGoogle Scholar
  20. 20.
    Louria DB, Blumenfeld HL, Ellis JT, et al. Studies on influenza in the pandemic of 1957–1958. II. Pulmonary complications of influenza. J Clin Invest. 1959;38:213–65.CrossRefGoogle Scholar
  21. 21.
    Klein EY, Monteforte B, Gupta A, Jiang W, May L, Hsieh YH, Dugas A. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2016;10:394–403.CrossRefGoogle Scholar
  22. 22.
    Martin-Loeches I, Schultz J, Vincent M, Alvarez-Lerma J-L, Bos F, Solé-Violán LD, Torres J, Rodriguez A. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med. 2017;43:48–58.CrossRefGoogle Scholar
  23. 23.
    Cauley LS, Vella AT. Why is co-infection with influenza virus and bacteria so difficult to control? Discov Med. 2015;19:33–40.Google Scholar
  24. 24.
    Louie JK, Yang S, Acosta M, Yen C, Samuel MC, Schechter R, Guevara H, Uyeki TM. Treatment with neuraminidase inhibitors for critically ill patients with influenza A (H1N1)pdm09. Clin Infect Dis. 2012;55:1198–1204.CrossRefGoogle Scholar
  25. 25.
    Muthuri SG, Venkatesan S, Myles PR, Leonardi-Bee J, Al Khuwaitir TS, Al Mamun A, Anovadiya AP, Azziz-Baumgartner E, Báez C, Bassetti M, Beovic B, Bertisch B, Bonmarin I, Booy R, Borja-Aburto VH, Burgmann H, Cao B, Carratala J, Denholm JT, Dominguez SR, Duarte PA, Dubnov-Raz G, Echavarria M, Fanella S, Gao Z, Gérardin P, Giannella M, Gubbels S, Herberg J, Iglesias AL, Hoger PH, Hu X, Islam QT, Jiménez MF, Kandeel A, Keijzers G, Khalili H, Knight M, Kudo K, Kusznierz G, Kuzman I, Kwan AM, Amine IL, Langenegger E, Lankarani KB, Leo YS, Linko R, Liu P, Madanat F, Mayo-Montero E, McGeer A, Memish Z, Metan G, Mickiene A, Mikić D, Mohn KG, Moradi A, Nymadawa P, Oliva ME, Ozkan M, Parekh D, Paul M, Polack FP, Rath BA, Rodríguez AH, Sarrouf EB, Seale AC, Sertogullarindan B, Siqueira MM, Skręt-Magierło J, Stephan F, Talarek E, Tang JW, To KK, Torres A, Törün SH, Tran D, Uyeki TM, Van Zwol A, Vaudry W, Vidmar T, Yokota RT, Zarogoulidis P, PRIDE Consortium Investigators, Nguyen-Van-Tam JS. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014;2:395–404.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Spiridon Topoulos
    • 1
  • Christian Giesa
    • 1
  • Sören Gatermann
    • 2
  • Rene Fussen
    • 3
  • Sebastian Lemmen
    • 3
  • Santiago Ewig
    • 1
    Email author
  1. 1.Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt BochumThoraxzentrum RuhrgebietBochumGermany
  2. 2.Ruhr-Universität Bochum, Institut für Mikrobiologie (IML)BochumGermany
  3. 3.Zentralbereich für Krankenhaushygiene und InfektiologieUniversitätsklinikum AachenAachenGermany

Personalised recommendations