Course of Illness after Viral Infection in Indian Children with Cystic Fibrosis

Gulla, Krishna Mohan; Arvind, Balaji; Mukherjee, Aparna; Jat, Kana Ram; Sankar, Jhuma; Lodha, Rakesh; Kabra, S. K.

doi:10.1093/tropej/fmy033

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…Our study found improved lung function in both groups at 3‐ and 6‐month follow‐up time points, but it may not be sustained in the long term due to a variety of factors including treatment adherence, intercurrent illnesses, and/or recurrent PEs 1,3 . There is also variability in the reported severity of viral‐positive PEs ranging from severe exacerbations requiring hospitalization and longer duration of intravenous antibiotic to a lower acute fall in ppFEV1 compared to viral‐negative PEs 10,11,17,22,23 . In this study, patients with viral‐positive PE had a shorter duration of hospitalization for PE compared to the viral‐negative PE group.…”

Section: Discussionmentioning

confidence: 55%

“…1,3 There is also variability in the reported severity of viralpositive PEs ranging from severe exacerbations requiring hospitalization and longer duration of intravenous antibiotic to a lower acute fall in ppFEV1 compared to viral-negative PEs. 10,11,17,22,23 In this study, patients with viral-positive PE had a shorter duration of hospitalization for PE compared to the viral-negative PE group. This finding could be attributed to the younger age and higher baseline ppFEV1 of the viral-positive PE group affecting recovery from PEs.…”

Section: T a B L E 1 Clinical Characteristics Of The Viral-positive A...mentioning

confidence: 59%

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Impact of viral respiratory infections on pulmonary exacerbations in children with cystic fibrosis

Gonzalez-Rosales

Kasi

Silva

et al. 2022

Pediatric Pulmonology

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Background Viral respiratory infections trigger pulmonary exacerbations (PEs) in children with cystic fibrosis (CF), but their clinical impact is not well understood. Methods A retrospective review of pediatric patients with CF who underwent nasopharyngeal respiratory viral panel testing during hospitalization for a PE between 2011 and 2018 was conducted. Patients were dichotomized into viral‐positive and viral‐negative groups. The results of spirometry, respiratory cultures, duration of hospitalization, and risk for subsequent PEs were analyzed. Results Ninety‐five patients had 210 hospitalizations for PE (viral‐positive = 71/210, 34%) during the study period. Rhinovirus/enterovirus was the most common virus (52/71, 73%) identified. Viral‐positive patients were younger (p < 0.001), had higher baseline forced expiratory volume in 1 s (FEV1) (p = 0.037), continued to maintain higher FEV1 at 3 and 6 months following PE (p = 0.003 and 0.002, respectively), and had a shorter duration of hospitalization (p = 0.006) compared to the viral‐negative group. There was no difference between the two groups in the rate of recovery of FEV1 at 3 and 6 months following PE (p = 0.71 and 0.405, respectively), time to the next PE (hazard ratio = 1.34, p = 0.157), number of subsequent PEs in 6 months (p = 0.99), or Pseudomonas aeruginosa (PA) acquisition (p = 0.707). Conclusions In this single pediatric CF center cohort, one‐third of PEs requiring hospitalization were associated with a viral infection, with rhinovirus/enterovirus being the most common. Viral‐positive PEs were not associated with a greater decline or delayed recovery of lung function, increased risk for PA acquisition, shortened duration to next PE, longer hospital stay, or an increase in the frequency of subsequent PEs in 6 months compared to viral‐negative PEs.

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Section: Discussionmentioning

confidence: 55%

Section: T a B L E 1 Clinical Characteristics Of The Viral-positive A...mentioning

confidence: 59%

Impact of viral respiratory infections on pulmonary exacerbations in children with cystic fibrosis

Gonzalez-Rosales

Kasi

Silva

et al. 2022

Pediatric Pulmonology

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“…Viral infection in children with CF can cause pulmonary exacerbations due to direct infection, as well as secondary bacterial infection [ 9 ]. Both of the above-mentioned cases had poor respiratory health with pulmonary exacerbations after SARS-CoV-2 infection, despite having well-controlled disease in the previous year.…”

Section: Discussionmentioning

confidence: 99%

Poor Respiratory Health Following Relapsing SARS-CoV-2 Infection in Children with Cystic Fibrosis

et al. 2022

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Children with cystic fibrosis (CF) constitute a high-risk group for COVID-19 with underlying chronic lung disease. COVID-19 severity varying from mild infection to need of intensive care has been described in children with CF. Two children with significant underlying pulmonary morbidity are described here, who developed severe disease following SARS-CoV-2 infection. Case 1 (a 9-y-old boy) had pneumonia with respiratory failure requiring noninvasive ventilation support. He had delayed clearance of SARS-CoV-2, with recurrence of symptomatic disease with short asymptomatic period in between. He was also diagnosed with CF-related diabetes and allergic bronchopulmonary aspergillosis during the second episode. Case 2 (an 18-mo-old boy) had two episodes of SARS-CoV-2–related severe lower respiratory infection within a period of 2 mo, requiring high-flow nasal oxygen support. Both children had 3 rd pulmonary exacerbation but SARS-CoV-2 was not detected in respiratory secretions. To conclude, children with CF with underlying pulmonary morbidity, can develop severe COVID-19 and prolonged SARS-CoV-2 shedding. Supplementary Information The online version contains supplementary material available at 10.1007/s12098-021-04057-0.

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“…For people CF, the clinical relevance of respiratory viral infections was present long before the recent global COVID-19 pandemic, with clear associations between acquisition of respiratory viruses and risk of CF exacerbations [19,20] and in some cases potentially significant disease progression [21,22]. Respiratory viruses are commonly detected from samples taken at both routine and emergency CF outpatients consultations [20] and spread of influenza infection among CF inpatients, with adverse clinical morbidity following infection, has been highlighted in two recent studies [23 ▪ ,24].…”

Section: Coronavirus Disease 2019 and Other Respiratory Viral Infectionsmentioning

confidence: 99%

Infection control in cystic fibrosis: evolving perspectives and challenges

Jones¹

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewThis article reviews the impact of some of the most recent changes in clinical care management in cystic fibrosis on infection prevention practice and advice for people with cystic fibrosis. Recent findingsPeople with cystic fibrosis (CF) consistently highlight infection control as one of their major concerns. Infection prevention guidance and practice has facilitated successful decreases in rates of many transmissible CF pathogens. The coronavirus disease 2019 pandemic highlighted the clinical significance of respiratory viral infections and has accelerated the implementation of remote monitoring and telemedicine consultations as standard practice in CF. The continued improvement in health of the CF population is being further augmented by the introduction of new therapies, in particular cystic fibrosis transmembrane conductance regulator modulators. Infection prevention will remain pertinent to CF care, but these recent changes in clinical practice will have ongoing implications for infection prevention guidance in CF. SummaryRecent changes in CF clinical care have implications that will lead to further evolution of infection control practice and advice.

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Course of Illness after Viral Infection in Indian Children with Cystic Fibrosis

Abstract: Acute viral infection in children with CF affected course of illness on follow-up, including frequent and severe pulmonary exacerbations requiring hospitalization, intravenous antibiotics, decline in CF scores and increased mortality over next 12-18 months.

Cited by 6 publications

References 27 publications

Impact of viral respiratory infections on pulmonary exacerbations in children with cystic fibrosis

Impact of viral respiratory infections on pulmonary exacerbations in children with cystic fibrosis

Poor Respiratory Health Following Relapsing SARS-CoV-2 Infection in Children with Cystic Fibrosis

Infection control in cystic fibrosis: evolving perspectives and challenges

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