Lessons of the month: Co-infection with SARS-CoV-2 and influenza B virus in a patient with community-acquired pneumonia (2020)

Type of publication:
Journal article

Author(s):
*Coutinho A.; *Riaz A.; *Makan A.; *Crawford E.; *Dev D.; *Srinivasan K.; *Ahmad N.; *Moudgil H.

Citation:
Clinical medicine (London, England); Nov 2020; vol. 20 (no. 6); e262–3

Abstract:
Why we only infrequently detect or report two or more respiratory viruses co-infecting an adult host is poorly understood. We report a rare case where influenza B and SARS-CoV-2 caused viral pneumonia in a 74-year-old man diagnosed during the UK winter epidemic/pandemic for these organisms and discuss concepts of co-infection.

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Cellular response to influenza infection: Lymphopenia and a reduced lymphocyte/monocyte ratio (2019)

Type of publication:
Conference abstract

Author(s):
*Abdulsamad S.P.; *Bhatia K.; *Khalid H.; *Makan A.; *Crawford E.; *Ahmad N.; *Srinivasan K.; *Moudgil H.

Citation:
European Respiratory Journal; Sep 2019; vol. 54, PA2383

Abstract:
Objectives: Provisional work has proposed a diagnostic role investigating cellular responses in acute viral respiratory pathology. Analysing patients with influenza(flu), objectives were(1)to assess magnitude of lymphocyte and monocyte responses in acute infection and(2)report on the potential benefit if detecting lymphopenia and a reduced lymphocyte to monocyte ratio(LMR)
Methods: Retrospective analysis of all adults with flu admitted to this trust during winter season 2016/7. Computer records provided differential white cell counts as relative(%of total white cell counts, WCC)and absolute counts for lymphocytes(normal range 1-4×109)and monocytes(0.1-0.9×109);analysis was with SPSS
Results: 143(54% female)adults(142 Flu A [H3N2]and 1 Flu B)were admitted. Mean age was 70.3(SD 19.4, range 20-98)years. Flu was primary diagnosis for 53(37%);43/90(48%) remaining also had a respiratory presentation. Lymphocyte count<20% WCC presented in 122(85%)and monocyte count >10%WCC in 43 (30%)with both markers in 35(25%). Lymphocyte counts were skewed, median 0.8(IQ 0.5-1.2)with lymphopenia at initial testing in 87(60%);among others there was a fall from admission values in 45 (31%). The lymphocyte/monocyte ratio (LMR) was <2 in 115(80%)of all presentations and specifically in 82/87(94%)with initial lymphopenia
Conclusion(s): Irrespective of whether primarily with flu or as a concurrent illness, acute lymphopenia and a LMR<2 at presentation as a measure of cellular response in admitted patients potentially presents an early and alternative strategy identifying patients with acute flu. Future work is required to establish sensitivity, specificity, negative and positive predictive values in a wider unselected similar population.

Uptake of influenza vaccination as a preventive health care strategy (2019)

Type of publication:
Conference abstract

Author(s):
*Ibrahim J.; *Ali J.; *Ali A.; *Makan A.; *Crawford E.; *Ahmad N.; *Srinivasan K.; *Moudgil H.

Citation:
American Journal of Respiratory and Critical Care Medicine; May 2019; vol. 199 (no. 9)

Abstract:
Introduction: Whether our local Health Care Economy is adequately prepared with uptake of targeted preventative strategies of seasonal influenza vaccination for the consequential burden on secondary health care is poorly documented. Auditing patients admitted acutely through our Acute Medical Unit, objectives were to (1) provide a point prevalence measure to the uptake of influenza vaccine among patients stratified by at risk groups, and (2) document reasons for nonadherence to current recommendations. Method(s): Auditing on three alternate days during one week in January 2018 coinciding with peak season for influenza, adult patients (>16yrs) acutely admitted were categorized and individually questioned using National Institute for Health and Care Excellence (NICE) guidelines for “immunization against Seasonal Influenza” as a benchmark identifying targeted strategies by clinical risk grouping: Group A was based on age years, and Group B on those below this age but with defined clinical risks. Comparative but surrogate standards for the groups were adopted from World Health Organization (WHO) targets and from Public Health England for uptake achievements by patients under local General Practitioners (GPs) in the West Midlands (WM) region. This audit did not consider the impact of vaccination on illness. Result(s): 120/136 (88.2%) admitted patients were audited; of these 75/120 (62.5%) had been vaccinated. Comparisons with standards adopted are shown in figure 1. Featured among 37.5% not vaccinated were GP appointments (60%), allergy (24%), low risk (9%) and mis-trust (7%). At risk groups were chronic respiratory (32%), cardiac (19%), neurological (14%) disease and diabetes (12%), cancer (7%), and others (16%). Conclusion(s): Among those admitted to secondary care, local Health Care Economy (figure 1) fall short of adopted standards from the WHO and regionally for WM region for Group A but with better figures for Group B comparing regionally, and (2) identify access at local GPs as among primary reasons for non-uptake of vaccination. (Figure Presented).

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