The complex link between influenza and severe sepsis

Florescu, Diana F.; Kalil, André C.

doi:10.4161/viru.27103

Cited by 52 publications

(54 citation statements)

References 91 publications

(133 reference statements)

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“…Our mortality estimates are likely underestimates of true burden of influenza mortality. The survey may have missed deaths, especially among infants who may have presented with sepsis rather than respiratory symptoms . Even among adults, it is possible that they had an underlying illness that made it difficult to classify as ARI through a community survey.…”

Section: Discussionmentioning

confidence: 99%

Estimates of seasonal influenza‐associated mortality in Bangladesh, 2010‐2012

Ahmed

Aleem

Roguski

et al. 2017

Influenza Resp Viruses

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BackgroundSeasonal influenza‐associated mortality estimates help identify the burden of disease and assess the value of public health interventions such as annual influenza immunization. Vital registration is limited in Bangladesh making it difficult to estimate seasonal influenza mortality.ObjectivesOur study aimed to estimate seasonal influenza‐associated mortality rates for 2010‐2012 in Bangladesh.MethodsWe conducted surveillance among hospitalized patients with severe acute respiratory illness (SARI) for persons aged ≥5 years and severe pneumonia for children <5 years in 11 sites across Bangladesh. We defined the catchment areas of these sites and conducted a community survey in 22 randomly selected unions (administrative units) within the catchment areas to identify respiratory deaths. We multiplied the proportion of influenza‐positive patients at our surveillance sites by the age‐specific number of respiratory deaths identified to estimate seasonal influenza‐associated mortality.ResultsAmong 4221 surveillance case‐patients, 553 (13%) were positive for influenza viruses. Concurrently, we identified 1191 persons who died within 2 weeks of developing an acute respiratory illness within the catchment areas of the surveillance hospitals. In 2010‐2011, the estimated influenza‐associated mortality rate was 6 (95% CI 4‐9) per 100 000 for children <5 years and 41 (95% CI 35‐47) per 100 000 for persons >60 years. During 2011‐2012, the estimated influenza‐associated mortality rate was 13 (95% CI 10‐16) per 100 000 among children <5 years and 88 (95% CI 79‐98) per 100 000 among persons aged >60 years.ConclusionsWe identified a substantial burden of influenza‐associated deaths in Bangladesh suggesting that the introduction of prevention and control measures including seasonal vaccination should be considered by local public health decision‐makers.

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Section: Discussionmentioning

confidence: 99%

Estimates of seasonal influenza‐associated mortality in Bangladesh, 2010‐2012

Ahmed

Aleem

Roguski

et al. 2017

Influenza Resp Viruses

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“…The immune response to influenza shares many common pathways with the response to bacteria, thus it should not be surprising that an influenza virus infection can have a very similar clinical presentation to bacterial sepsis [9,47,48]. Specifically, several studies have demonstrated that both Toll-like receptors 2 and 4, which are the main receptors for Gram-positive and Gramnegative bacteria, are also related to influenza pathogenicity [49][50][51].…”

Section: Influenza Presenting As Sepsismentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

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“…A common and severe complication of sepsis is renal insufficiency. Impaired renal function accentuates the pathogenesis of sepsis through the loss of metabolic, fluid, and electrolyte homeostasis (Hotchkiss et al, 2013;Florescu and Kalil, 2014), and the development of kidney dysfunction doubles the risk for mortality in septic patients (Boomer et al, 2014). Bacterial sepsis and acute endotoxemia induce a number of defects, but the underlying mechanisms remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

MicroRNA-29a promotes apoptosis of monocytes by targeting STAT3 during sepsis

Song¹,

Wang²,

Geng³

2015

Genet. Mol. Res.

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ABSTRACT. Sepsis is a major cause of morbidity and mortality in critically ill patients. The sepsis syndrome results from a dysregulated inflammatory response to infection that leads to multiple-organ failure, but the underlying mechanisms remain poorly understood. More and more reports show that microRNAs (miRNAs) play an important role in sepsis. In the progression of this syndrome, cells change their behavior in response to cytokines stimulated by sepsis, such as interleukin-10 (IL-10). IL-10 can activate JAK2-STAT3 in the cells to protect them from damage. miR-29a is a potential miRNA directly targeting STAT3. In this study, we investigate the role of miR-29a in targeting STAT3 during sepsis. When cells were treated with IL-10, STAT3 was activated in monocytes, as determined using western blotting. It was verified that STAT3 was a new target gene of miR-29a. miR-29a could inhibit IL-10-induced cytokine release by targeting JAK-STAT3 in monocytes. In conclusion, this study demonstrates for the first time that miR-29a inhibits STAT3 in human monocytes during sepsis.

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The complex link between influenza and severe sepsis

Cited by 52 publications

References 91 publications

Estimates of seasonal influenza‐associated mortality in Bangladesh, 2010‐2012

Estimates of seasonal influenza‐associated mortality in Bangladesh, 2010‐2012

Influenza virus-related critical illness: pathophysiology and epidemiology

MicroRNA-29a promotes apoptosis of monocytes by targeting STAT3 during sepsis

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