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Background Respiratory tract infections (RTIs) are a major global health burden due to their high morbidity and mortality. This retrospective study described the epidemiology of respiratory pathogens in adults over a 5-year period at an Australian tertiary healthcare network. Methods All multiplex reverse transcription polymerase chain reaction respiratory samples taken between the 1st of November 2014 and the 31st of October 2019 were included in this study. Overall prevalence and variations according to seasons, age groups and sex were analysed, as well as factors associated with prolonged hospital and intensive care length of stay. Results There were 12,453 pathogens detected amongst the 12,185 positive samples, with coinfection rates of 3.7%. Picornavirus (Rhinovirus ), Influenza A and respiratory syncytial virus were the most commonly detected pathogens. Mycoplasma pneumoniae was the most commonly detected atypical bacteria. Significant differences in the prevalence of Chlamydia pneumoniae and Human metapneumovirus infections were found between sexes. Longest median length of intensive care and hospital stay was for Legionella species. Seasonal variations were evident for certain pathogens. Conclusions The high rates of pathogen detection and hospitalisation in this real-world study highlights the significant burden of RTIs, and the urgent need for an improved understanding of the pathogenicity as well as preventative and treatment options of RTIs.

The co‐existence of idiopathic hemosiderosis and celiac disease is Lane‐Hamilton Syndrome. This is a rare condition with only a few dozen cases reported to date. Its clinical presentation typically involves hemoptysis that can be life‐threatening in the acute phase. We report the uncommon case of the development of idiopathic pulmonary hemosiderosis almost a decade after the diagnosis of celiac disease. Delayed diagnosis led to recurrent episodes of large volume hemoptysis despite immunosuppressive therapy due to ongoing ingestion of gluten. High doses of glucocorticoids accompanied by a cell cycle inhibitor mycophenolate mofetil were required for treatment. A strict gluten free diet is vital to control the disease. We highlight the importance of identifying this syndrome and definitive treatment, including avoidance of dietary triggers in addition to conventional immunosuppressive therapy. We present a previously undescribed occurrence of Lane‐Hamilton syndrome, where there was a notable latency between abdominal and pulmonary manifestations. This resulted in a diagnostic delay and disease control was ultimately achieved through immunosuppression and a gluten free diet, highlighting the importance in achieving a timely diagnosis.

Acute carbon monoxide (CO) poisoning is known to cause neurological, metabolic and cardiorespiratory sequalae. However, data on chronic CO exposure are scant, particularly in the context of vaping, which recent literature suggests may be a greater source of CO than tobacco cigarette smoking. During a series of admissions at the time of vaping, our patient repeatedly presented with significant CO poisoning and developed pulmonary arterial hypertension with resultant high‐output right heart failure. On each occasion, our patient's levels of carboxyhaemoglobin were both higher and took longer to resolve than 12 smokers who underwent arterial blood gas testing at two time points. Our observation may reveal an association between vaping, chronic carboxyhaemoglobinemia and the development of cardiorespiratory disease. Thus, further studies into the safety of vaping and chronic CO exposure are urged. This case highlights vaping as a cause of recurrent and severe carboxyhaemoglobinemia to a degree much greater than is seen with cigarette smoking. Pulmonary hypertension and death were the eventual sequelae.