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Background Lower respiratory tract infections (LRTIs) are a major global health concern, particularly among older adults, who have an increased risk of poorer health outcomes that persist beyond the acute infectious episode. We aimed to investigate the mid-term (up to 7 years) and long-term (up to 12 years) effects of LRTIs on the objective health status trajectories of older adults, while also considering potential sex differences. Methods Cohort data of adults aged ≥ 60 years from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) collected between 2001 and 2016 was analyzed. Information on LRTIs was obtained from the Swedish National Patient Register, and objective health status was assessed using the Health Assessment Tool (HAT) which incorporates indicators of mild and severe disability, cognitive and physical functioning, and multimorbidity. The LRTI-exposed and -unexposed participants were matched using propensity score matching based on an expansive list of potential confounders. Mixed linear models were used to analyze the association between LRTIs and changes in HAT scores. Results The study included 2796 participants, 567 of whom were diagnosed with a LRTI. LRTIs were independently associated with an excess annual decline of 0.060 (95% CI: -0.107, -0.013) in the HAT score over a 7-year period. The associations were stronger among males, who experienced an excess annual decline of 0.108 (95% CI: -0.177, -0.039) in up to 7-years follow-up, and 0.097 (95% CI: -0.173, -0.021) in up to 12-years follow-up. The associations were not statistically significant among females in either follow-up period. Conclusion LRTIs, even years after the acute infectious period, seem to have a prolonged negative effect on the health of older adults, particularly among males. Preventative public health measures aimed at decreasing LRTI cases among older adults could help in preserving good health and functioning in old age.

Objective: This study aimed to explore the epidemiological trend and clinical characteristics of respiratory syncytial virus (RSV) infection among inpatient children with lower respiratory tract infection (LRTI) before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A retrospective study of inpatients with LRTI was conducted at the Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine (Hangzhou, China) from January 2019 to December 2021. All respiratory specimens were tested for common respiratory pathogens. The clinical data in children with RSV-induced LRTI in the past three years were collected and analyzed. Results: A total of 11,290 patients were enrolled, and RSV positive cases were 402 (7.6%), 288 (9.6%), 415 (13.8%) in 2019, 2020, 2021, respectively, with a significant statistical difference of the RSV positive rate among the three groups (p < 0.001). Most patients were under 2-year old, especially under 1-year old, and the median age of patients was 4 months, 5 months, 6 months in 2019, 2020, 2021, respectively, with a tendency to increase in age. In terms of the seasonal distribution, most patients of LRTI with RSV infection were admitted in winter, while in 2021 compared with in 2019, the cases significantly reduced in winter and increased in autumn. From 2019 to 2021, there was an increase in autumn trend year by year. Conclusion: RSV infection was still an important cause of hospitalization in children with LRTI after the outbreak of COVID-19, and its proportion increased gradually. LRTI caused by RSV is still more common in infants under 1-year old, but there is a trend of increasing in older children. What deserves the attention of pediatricians and Center for Disease Control is that the incidence of RSV infection continues to rise in autumn, and the difference in seasonal distribution is narrowed. Keywords: respiratory syncytial virus, RSV, COVID-19, lower respiratory tract infection, non-pharmaceutical interventions

Lower respiratory tract illness or disease (LRTI/LRTD) represents a significant source of morbidity and mortality following viral respiratory illnesses, yet a consensus definition for this outcome is lacking. Recent studies of novel vaccines against respiratory syncytial virus (RSV) for older adults used LRTI/LRTD as the primary outcome to assess vaccine efficacy. However, the different vaccine trials have used highly variable criteria to define this outcome, leading to difficulty in comparison of vaccine efficacy results between trials. Here we review the key differences in criteria for case definitions, highlight strategies to best approximate compatibility between definitions, and review vaccine efficacy results among currently US Food and Drug Administration (FDA)-approved vaccines using these strategies. We hope this overview will support the need to develop a consensus definition for LRTI/LRTD to improve future research related to viral respiratory disease.

This study examines the distribution characteristics of pathogenic bacteria in respiratory infections and their relationship with inflammatory markers to guide clinical drug use. We selected 120 patients with lower respiratory tract infection in the electronic medical record system of Xinjiang Provincial People's Hospital from March 2019 to March 2023 for a case-control study. Using Indirect Immunofluorescence Antibody test(IFA), blood routine, C-reactive Protein (CRP), and High-sensitivity C-reactive Protein(hsCRP), we detected nine respiratory pathogens (Respiratory syncytial virus; Influenza A virus; Influenza B virus; Parainfluenza virus; Adenovirus; Mycoplasma pneumoniae; Chlamydia pneumoniae; Legionella pneumophila type 1; Rickettsia Q) in all patients and analyzed their distribution and correlation. The patients were divided into three groups [Respiratory Syncytial Virus Immunoglobulin M(RSV-IgM) positive group A, Mycoplasma Immunoglobulin M(MP - IgM) positive group B, antibody - negative group with elevated hsCRP, 40 patients each]. We compared differences in hsCRP, platelet count, White Blood Cells(WBC), and Neutrophil(NE) among the groups. We conducted a systematic sorting and analysis of variables exhibiting significant differences. The results of the multivariate logistic regression analysis indicated that inflammatory markers, including white blood cell count (WBC) (OR 3.85, 95% CI: 1.116-1.623), neutrophils (NE) (OR 2.26, 95% CI: 1.091-1.312), high-sensitivity C-reactive protein (HsCRP) (OR 1.95, 95% CI: 1.068-14.640), lymphocytes (OR 1.30, 95% CI: 1.045-1.134), platelet count (OR 1.34, 95% CI: 1.625-2.760), and C-reactive protein (CRP) (OR 3.80, 95% CI: 1.232-2.379), were significantly associated with the presence of pathogenic bacteria. There was significant correlation between inflammatory markers and pathogenic bacteria in patients with lower respiratory tract infection in Xinjiang region.

Introduction: Respiratory syncytial virus (RSV) is one of the most important childhood infections. Objective: To evaluate the effectiveness and safety of palivizumab immunoprophylaxis in preterm infants at a high risk of severe respiratory syncytial virus infection during the RSV season in Colombia. Methodology: A prospective observational non-comparative multicenter study in six Colombian cities. At the beginning of the RSV infection season, palivizumab prophylaxis, up to five doses, was administered to infants born at ≤32 weeks of gestation, infants younger than six months, infants under one year of age with bronchopulmonary dysplasia (BPD), infants one year or less of age with hemodynamically significant acyanotic and non-acyanotic congenital heart disease (CHD), and with follow-up during the immunoprophylaxis until one month after the last dose. Results: The study enrolled 600 patients, 91.8% of which were born at ≤ 32 weeks of gestation. BPD was observed in 54.9% of infants. 49% were born at < 32 weeks gestation and presented BPD. 6.9% had hemodynamically significant acyanotic and non-acyanotic CHD 53.3% received three or more doses of palivizumab. The mean interval between doses was 39.6 days. 1.8% of patients were hospitalized due to a confirmed RSV infection. Overall mortality was 1.2%, whereas the mortality by RSV in infants undergoing prophylaxis was 0.2%. Conclusions: Palivizumab was a clinically effective, well-tolerated treatment in the Colombian population. The safety profile of palivizumab reflects the findings from previous studies in developed countries.

The objective of this study was to describe the overall pattern of morbidity and mortality of children seen at the Thai Binh Paediatric Hospital in Vietnam, with a focus on infectious diseases. A retrospective review of hospitalisation records was conducted from 1 January 2015 to 31 December 2019. Data were obtained from a total of 113,999 records. The median age of patients was 18 months, with 84.0% of patients aged <5 years. Infectious diseases accounted for 61.0% of all cases. The most prevalent diseases were lower respiratory tract infections (32.8%), followed by gastrointestinal infections (13.3%) and confirmed influenza (5.4%). Most infections were not microbiologically documented. A total of 81.4% patients received at least one antibiotic. Most patients (97.0%) were hospitalised for less than 15 days. Regarding outcomes, 87.8% patients were discharged home with a favourable outcome. Twelve percent were transferred to the Vietnam National Children’s Hospital because their condition had worsened and 0.1% died. In total, infectious diseases accounted for 40.4% of deaths, followed by neonatal disorders (34.6%). Our data serves a basis for the identification of needs for diagnostic tools and for future evaluation of the effect of the targeted implementation of such facilities. Point-of-care tests, including real-time polymerase chain reaction assays to identify common pathogens should be implemented for more accurate diagnosis and more appropriate antibiotic use.

Lower respiratory tract infections (LRTIs) lead to more deaths each year than any other infectious disease category. Despite this, etiologic LRTI pathogens are infrequently identified due to limitations of existing microbiologic tests. In critically ill patients, noninfectious inflammatory syndromes resembling LRTIs further complicate diagnosis. To address the need for improved LRTI diagnostics, we performed metagenomic next-generation sequencing (mNGS) on tracheal aspirates from 92 adults with acute respiratory failure and simultaneously assessed pathogens, the airway microbiome, and the host transcriptome. To differentiate pathogens from respiratory commensals, we developed a rules-based model (RBM) and logistic regression model (LRM) in a derivation cohort of 20 patients with LRTIs or noninfectious acute respiratory illnesses. When tested in an independent validation cohort of 24 patients, both models achieved accuracies of 95.5%. We next developed pathogen, microbiome diversity, and host gene expression metrics to identify LRTI-positive patients and differentiate them from critically ill controls with noninfectious acute respiratory illnesses. When tested in the validation cohort, the pathogen metric performed with an area under the receiver-operating curve (AUC) of 0.96 (95% CI, 0.86–1.00), the diversity metric with an AUC of 0.80 (95% CI, 0.63–0.98), and the host transcriptional classifier with an AUC of 0.88 (95% CI, 0.75–1.00). Combining these achieved a negative predictive value of 100%. This study suggests that a single streamlined protocol offering an integrated genomic portrait of pathogen, microbiome, and host transcriptome may hold promise as a tool for LRTI diagnosis.

Background: Lower respiratory tract infections (LRTI) are a common reason for consulting general practitioners (GPs). In most cases the aetiology is unknown, yet most result in an antibiotic prescription. The aetiology of LRTI was investigated in a prospective controlled study. Methods: Eighty adults presenting to GPs with acute LRTI were recruited together with 49 controls over 12 months. Throat swabs, nasal aspirates (patients and controls), and sputum (patients) were obtained and polymerase chain reaction (PCR) and reverse transcriptase polymerase chain reaction (RT-PCR) assays were used to detect Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, influenza viruses (AH1, AH3 and B), parainfluenza viruses 1–3, coronaviruses, respiratory syncytial virus, adenoviruses, rhinoviruses, and enteroviruses. Standard sputum bacteriology was also performed. Outcome was recorded at a follow up visit. Results: Potential pathogens were identified in 55 patients with LRTI (69%) and seven controls (14%; p<0.0001). The identification rate was 63% (viruses) and 26% (bacteria) for patients and 12% (p<0.0001) and 6% (p = 0.013), respectively, for controls. The most common organisms identified in the patients were rhinoviruses (33%), influenza viruses (24%), and Streptococcus pneumoniae (19%) compared with 2% (p<0.001), 6% (p = 0.013), and 4% (p = 0.034), respectively, in controls. Multiple pathogens were identified in 18 of the 80 LRTI patients (22.5%) and in two of the 49 controls (4%; p = 0.011). Atypical organisms were rarely identified. Cases with bacterial aetiology were clinically indistinguishable from those with viral aetiology. Conclusion: Patients presenting to GPs with acute adult LRTI predominantly have a viral illness which is most commonly caused by rhinoviruses and influenza viruses.

Background： Wheezing is common in early childhood and remains an important health concern. The aim of this study was to assess the lung function of wheezing infants and to investigate the relationship between lung function and respiratory outcome. Methods： Infants 〈2 years of age with acute lower respiratory tract infection （ALRTI） who had undergone lung function tests were included in the study. They were assigned to wheeze or no wheeze group based on physical examination. Infants without any respiratory diseases were enrolled as controls. Lung function was measured during the acute phase and 3 months after ALRTI. One-year follow-up for infants with ALRTI was achieved. Results： A total of 252 infants with ALRTI who had acceptable data regarding tidal breathing were included in the final analysis. Compared with the control and the no wheeze groups, infants in the wheeze group had significantly decreased time to peak tidal expiratory flow as a percentage of total expiratory time （TPTEF/TE） （20.1 1 6.4% vs. 34.4 ± 6.2% and 26.4 ±8.3%, respectively, P 〈 0.0001） and significantly increased peak tidal expiratory flow （PTEF） （90.7 ± 26.3 ml/s vs. 79.3 ± 18.4 ml/s and 86.1 ± 28.0 ml/s, respectively, P 〈 0.01）, sReff and Reff. The infants in the wheeze group still had lower TPTEF/TE and volume to peak tidal expiratory flow as a percentage of total expiratory volume （VPTEF/VE） than the no wheeze infants 3 months after the ALRT1. Moreover, there was a significant inverse relationship between TPTEF/TE, VPTEF/VE, and the recurrence of wheezing and pneumonia. Conclusions： Impaired lung function was present in wheezing infants with ALRTI and the deficits persisted. In addition, the lower level of TPTEF/TE and VPTEF/VE was a risk factor for poor respiratory outcome.

Background： The accuracy of nasopharyngeal aspirate （NPA） specimens in detecting lower respiratory pathogens remains controversial. The objective of this study was to evaluate the diagnostic accuracy of aspirates （NPAs） specimen in lower respiratory tract infections （LRTIs） in children. Methods： The prospective study was designed to collect the data of paired NPAs and bronchoalveolar lavage fluids from children with acute LRTIs from January 2013 to December 2015. All specimens were subjected to pathogen detection： bacterial detection by culture, Mvcoplasma pneumoniae （Mp） detection by polymerase chain reaction assay and virus （influenza A and B viruses, parainfluenza virus [PIV] Types 1 and 3, respiratory syncytial virus, and adenovirus） detection by immunofluorescence assay. The diagnostic accuracy analysis of NPAs was stratified by age ≤3 years （n = 194） and 〉3 years （n = 294）. Results： We collected paired specimens from 488 children. The positive rate of pathogen was 61.6%. For Streptococcus pneumoniae, NPA culture had the specificity of 89.9% and negative predictive value of 100% in age ≤3 years, the specificity of 97.2% and negative predictive value of 98.9% in age 〉3 years. For Mp, the positive predictive values of NPA was 77.4% in children ≤3 years, and 89.1% in children 〉3 years. For PIV III, NPA specimen had the specificity of 99.8% and negative predictive value of 96.5% in children ≤3 years. For adenovirus, NPA had the specificity of 97.8% and negative predictive value of 98.4% in age ≤3 years, the specificity of 98.9% and negative predictive value of 99.3% in age 〉3 years. Conclusions： NPAs are less invasive diagnostic respiratory specimens, a negative NPA result is helpful in ＂rule out＂ lower airway infection; however, a positive result does not reliably ＂rule in＂ the presence of pathogens.