Adult croup: a rare but more severe condition

We report the first adult patient with virologically confirmed croup caused by parainfluenza virus type 3 and review 10 cases of adult croup described in the English-language literature. Circumstantial evidence of viral infection was present in only 1 other case, in which there was a rise in antibody titer against influenza B virus. Ten patients (91%) required intensive care support. None of the 11 patients died. A comparison was also made between the 11 adults with croup and 43 children hospitalized with severe croup described in a representative paper published in 1984. Adult croup represents an apparently more severe disease entity than pediatric croup.     

Molecular Epidemiology of Influenza A(H1N1)pdm09 Virus among Humans and Swine,Sri Lanka

After multiple discrete introductions of influenza A(H1N1)pdm09 virus into Sri Lanka, the virus was transmitted among humans, then swine. The spread of virus between geographically distant swine farms is consistent with virus dispersal associated with a vehicle used for swine transportation, although this remains unproven.     

Effect of exogenous histidine and Garcinia cambogia on histamine formation in skipjack (Katsuwonus pelamis) homogenates

Histamine consumed with food gives rise to allergic reactions. Dark muscle fish, for example skipjack (Katsuwonus pelamis) has been shown to contain histamine. Studies using TLC (acetone: NH4OH, 80:20.5) on silica gel G60 plates and densitometry after spraying with ninhydrin, using a computerized densitometer, showed that freshly harvested skipjack has no detectable histamine (detection limit, 50 micrograms.g-1 fish). However, with time histamine (Rf 0.84) is formed > 1.5 mg.g-1 probably through microbial action. Skipjack contains high levels of free histidine at levels of > 10 mg.g-1 (Rf 0.41) but fish like seer (Scomberamous spp.), which are not reported to be allergenic, contain < 4 mg.g-1 histidine. Addition of exogenous histidine (50 mg.g-1) results in histamine formation in seer 2.2-fold that of skipjack under the same conditions. A type of herring (Amblygaster spp., sinhala-hurulla) is not a histamine former, but had been shown to cause allergenic reactions, resulting in a ninhydrin positive spot (Rf 0.79) on incubating for 24 hours. Addition of arginine and lysine to blended skipjack results in their loss probably by decarboxylation. Addition of the spice Garcinia cambogia (extracts 0.2 g ml-1) known as 'goraka' in Sri Lanka (sinhala) and 'kukum' in India (hindhi), to fresh skipjack incubates prevents histamine formation as a results of lowering pH to 3.2-3.6 whereas Avverhoea bilimbi (bilin) and Tamarindus indica (tamarind) extracts did not prevent histamine formation.     

Severe acute respiratory syndrome and dentistry: a retrospective view

BACKGROUND: Severe acute respiratory syndrome, or SARS, which has created panic in Asia and in some parts of North America, is the first epidemic of the new century. Although it has been well-contained, sporadic cases continue to emerge. OBJECTIVES: The authors trace the emergence of the SARS outbreak from southern China and its spread worldwide, discuss the viral etiology of the infection and its clinical features, and review the infection control guidelines issued during the outbreak by the health authorities in Hong Kong, the Centers for Disease Control and Prevention, the World Health Organization and the American Dental Association. They also review the prospects for a new outbreak and preventive measures. OVERVIEW: The disease, which is caused by a novel coronavirus termed the "SARS coronavirus," or SARS-CoV, essentially spreads through droplet infection and affects people of any age. It has a mortality rate ranging from 10 to 15 percent. A major hallmark of this disease has been the rate at which it has affected health care workers through nosocomial transmission; in some countries, up to one-fourth to one-third of those infected were in this category. However, no dental health care worker has been affected by SARS in a nosocomial or dental setting. CONCLUSIONS AND CLINICAL IMPLICATIONS: Researchers believe that a combination of factors, including the universal infection control measures that the dental community has implemented and/or the low degree of viral shedding in the prodromal phase of SARS, may have obviated the spread of the disease in dental settings. The dental community should reflect on this outbreak to reinforce the currently applied infection control measures.     

Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings

BACKGROUND: The clinical response of patients with severe acute respiratory syndrome (SARS) to a combination of lopinavir/ritonavir and ribavirin was examined after establishing the in vitro antiviral susceptibility of the SARS associated coronavirus to a panel of antiviral agents. METHODS: The in vitro susceptibility of the prototype of SARS associated coronavirus to a panel of nucleoside analogues and protease inhibitors currently licensed for clinical use was studied. Forty one patients with SARS followed for 3 weeks were treated with a combination of lopinavir/ritonavir and ribavirin. The clinical progress and virological outcomes were monitored and compared with 111 patients treated with ribavirin only who served as historical controls. RESULTS: In vitro antiviral activity against SARS associated coronavirus was demonstrated for lopinavir and ribavirin at concentrations of 4 micro g/ml and 50 micro g/ml, respectively, only at 48 hours. The adverse clinical outcome (ARDS or death) was significantly lower in the treatment group than in the historical controls (2.4% v 28.8%, p<0.001) at day 21 after the onset of symptoms. The adverse outcome remained significantly lower in the treatment group than in the controls-both those diagnosed early (p<0.001) and those diagnosed later in the course of the epidemic (p = 0.002)-but there was no significant difference in adverse outcome rates between the two time periods (p = 0.548). No time related difference in outcome was observed in the control groups. A reduction in steroid usage and nosocomial infections was seen in patients initially treated with lopinavir/ritonavir, and these patients had a decreasing viral load and rising peripheral lymphocyte count. Multivariate analysis showed that age, hepatitis B carrier status, and lack of treatment with this antiviral combination were independent predictors of an adverse outcome. Lopinavir/ritonavir treatment was associated with a better outcome even when adjusted for baseline lactate dehydrogenase level. CONCLUSIONS: The apparent favourable clinical response with lopinavir/ritonavir and ribavirin supports further randomised placebo controlled trials in patients with SARS.     

Excess hospital admissions for pneumonia, chronic obstructive pulmonary disease, and heart failure during influenza seasons in Hong Kong

It is widely held that Southern China is a hypothetical influenza epicentre for the emergence of pandemic influenza viruses. However, influenza is perceived as a relatively unimportant infection in this part of the world compared with western countries. Hong Kong is situated within the hypothetical epicentre and serves as a sentinel post for the region. In a retrospective study, the influenza-associated excess hospitalisations in a regional hospital for pneumonia, chronic obstructive pulmonary disease (COPD), heart failure, and asthma in persons aged > or = 65 years from 1998 to 2001 were each estimated by a model taking into consideration the confounding effect of other respiratory viral infections, seasonal factors, time trends, and weather and pollution indices. In the regression models, influenza activity is an independent significant factor affecting admission rates for pneumonia, COPD, and heart failure but not that for asthma. The variations in hospital admissions for pneumonia, COPD, and heart failure explained by influenza activity were 38.9, 7.5, and 45.6%, respectively. The adjusted rates of excess influenza-associated hospital admissions for the three diagnoses combined amounted to 58.5, 20.0, 29.2, and 13.4 per 10,000 populations aged > or = 65 years in 1998, 1999, 2000, and 2001, respectively. In conclusion, influenza activity is associated significant excess hospital admissions among elderly aged 65 or above in Hong Kong, comparable to the data reported in Western countries. The findings support a wider application of annual influenza vaccination in this region.