Showing posts with label respiratory infection. Show all posts
Showing posts with label respiratory infection. Show all posts

Monday, August 24, 2015

Infection-Related Hospitalizations in Childhood and Adult Cardiometabolic Disease: An Association You May Not Know About


By: Lewis First, MD, MS; Editor-in-Chief 
         
     We are always looking for early determinants of adult disease processes so we might be able to intervene sooner and abate serious morbidity up the road—but sometimes we discover a determinant that we had not suspected to be a contributor.  Take childhood infections for example and their influence, or at least their association with adult cardiometabolic disease.   
     Burgner et al. (doi:10.1542/peds.2015-0825) report this week on their study of a longitudinal cohort of children in Finland who were followed from ages 3- to 9-years onward until they were 30 to 45 years of age with data being accessible in terms of infection-related hospitalizations since birth as well as their degree of adiposity, body mass index and metabolic syndrome in adulthood.   
      The authors controlled for various confounders and discovered that early childhood infectious disease-related hospitalizations correlated significantly with increased BMI and metabolic syndrome even when age, sex, birthweight, childhood BMI, family income and other factors were controlled for.  In fact, the more infection-related hospitalizations, the higher the increase in adult BMI.  If this seems puzzling to you, it did to us initially as well until we read this study and learned from the discussion as to what role these infection-related inpatient stays might have with adult cardiometabolic outcomes.   
      You’ll want to weigh in to the results of this study—and then think about your patients from years back with recurrent hospitalizations for infections and whether or not they are tackling cardiac-related metabolic complications as adults as this study certainly suggests.

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Tuesday, December 9, 2014

RSV: Risk of Death


By: Lewis First, MD, MS; Editor-in-Chief 

With respiratory syncytial virus (RSV) season upon us, we know that our youngest and tiniest patients can experience significant morbidity with this virus in their system, but how fatal is it?

Byington et al.  (doi:10.1542/peds.2014-2151) looked at this question by using two large national databases to examine the past decade’s worth of hospitalizations for RSV, and in turn, the mortality associated with these hospitalizations.

The good news is that RSV deaths are extremely uncommon, although as you might expect, are most associated with infants with complex chronic conditions, making it tougher for them to deal with this respiratory infection.

Just what conditions are associated with increased RSV mortality awaits your reading of this useful description of a huge number of RSV admissions to determine the low prevalence of mortality reported. Take a deep breath and read this study to learn more that may help you reassure most families and perhaps be even more vigilant and supportive in your care of your more complex infants who succumb to RSV.

Related Reading:

Wednesday, November 19, 2014

The Duration of Nasal Shedding by Rhinovirus—What It Is and I(s-not)!

By: Lewis First, MD, MS; Editor-in-Chief 

Human rhinovirus-14. Photo by US Dept. of Energy.
Parents often tell us that their young child’s nose is always running. We like to say that if a child’s feet smell and her nose runs—it probably means she is upside down. But since this situation is unusual, the more common reason for rhinorrhea is a viral upper respiratory infection often caused by a strain of rhinovirus.

So just how long does rhinovirus hang around in a child’s nose? Or is it possible that children get different strains of rhinovirus mimicking a long-lasting strain?

Loeffelholz et al. (doi: 10.1542/peds. 2014-2132) set out to perform a longitudinal study of infants in their first year of life by collecting monthly nasopharyngeal samples as well as additional samples when upper respiratory infections occurred. They then ran the samples via reverse-transcription polymerase chain reaction (PCR) to look at nucleotide sequences for the strain of rhinovirus detected.

Researchers studies over 2,000 specimens from approximately 350 babies. What is most remarkable is that they identified more than 300 different rhinovirus infections involving upwards of 175 strains. Fewer than 10 infectious events represented prolonged infection more than 30 days long (i.e. found in two sequential monthly samples).

Before you start working up your patients for an immune dysfunction because their upper respiratory symptoms seem persistent, read this article. It may enable you to focus more on good URI preventive strategies of hand-washing, avoidance of second hand smoke exposure, and coughing and sneezing into an elbow rather than a hand—as time better spent than ordering a myriad of tests and cultures reflecting the spread of viral infections in otherwise healthy hosts.

The information in this article may be well worth sharing with families to avert the need for further laboratory testing and unnecessary use of antibiotics—but don’t take my word for it, you can be in the know (or in the nose) yourself if you give this study some attention.

Related Reading: