What is SARS?

It is an atypical severe pneumonia caused by SARS-Cov coronavirus (unknown at the time), a virus capable of surviving about three hours outside the host organism.

Coronaviruses are generally the main cause of mild to moderate respiratory illnesses such as the common cold, but which can worsen into pneumonia and acute respiratory syndromes, sometimes fatal.

Symptoms of SARS

The incubation period of SARS is rather short: between 2 and 7 days.

The first symptoms are very similar to those of influenza:

  • high fever (>38°C)
  • joint and muscle pain
  • dry throat
  • headaches
  • chills
  • cough
  • difficulty breathing.

In some cases, respiratory symptoms occur from the first onset of the disease and may worsen leading to hypoxia and pneumonia.

After about 7 days, the disease progresses with a dry cough that may lead to a poor oxygen supply to the blood and in 10-20% of cases may worsen to the point where supportive therapies such as assisted breathing, oxygen therapy or, in extreme cases, resuscitation are required. The mortality rate is around 9% (source: World Health Organisation).

SARS transmission, diagnosis and treatment

SARS is mainly spread by direct contact with infected patients, through their respiratory secretions (droplets of saliva expelled with coughs or sneezes) or their body fluids.

Diagnosis is made through the observation of symptoms and the results of a series of tests: chest X-ray, blood cell count (thrombocytopenia and leucopenia have been found in many patients), Gram culture and a search for respiratory viruses.

SARS is treated like any severe atypical pneumonia, i.e. mainly with antibiotics for bacterial and antiviral agents.

Oral or intravenous steroids may also be administered in combination with antimicrobials.

Preventive measures against SARS

As SARS is still being researched and therefore there is no vaccine or specific treatment, prevention still remains the only effective weapon to prevent the spread of the disease.

First and foremost, it is important to take some simple hygiene measures:

  • wash your hands often
  • cover your nose and mouth when coughing or sneezing;
  • avoid sharing towels, glasses and cutlery.

Like all infectious diseases, SARS is more easily transmitted in crowded and poorly ventilated places, where the concentration of pathogens can be noticeably high. Wearing a face mask can be a good way to protect yourself and others from the spread of SARS and other respiratory diseases.

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Elementary school teacher and her students wearing protective face mask in the classroom. Image credit: iStock

FACULTY Q&A

Andrew Ault
Andrew Ault

Since the Centers for Disease Control and Prevention acknowledged SARS-CoV-2 was airborne in spring 2020, University of Michigan aerosol scientists Andrew Ault and Kerri Pratt have advised public school systems on how to mitigate the transmission of COVID-19 in the classroom.

That’s partly because social distancing isn’t enough of a mitigation strategy. Have you ever smelled food burning in a kitchen or cigarette smoke in restaurants before indoor smoking was banned? Distance doesn’t automatically mean particles in the air aren’t reaching you, say the researchers.

Kerri Pratt
Kerri Pratt

Now, as students return to school, Ault and Pratt, both associate professors in the U-M Department of Chemistry, give tips about how teachers can keep their classrooms safer for themselves and their students. The key, they say? Masks, open windows, and HEPA filters, including a do-it-yourself air filter made out of furnace filters taped around a box fan.

Can you describe how airborne transmission of COVID works?

Airborne transmission means that a virus is spread by aerosols, which are tiny particles we exhale into the air when we are breathing and talking. The louder we are talking or harder we are breathing, the more aerosols we emit. When someone has COVID, those aerosols contain virus (SARS-CoV-2), which can infect others that breathe the aerosols in. These aerosols are so small (100 times smaller than the diameter of a human hair) that they can stay in the air for hours.

What are some ways people can visualize airborne transmission via aerosols?

You can think of aerosol transmission like cigarette smoke, which is similar in size to exhaled aerosol. Smoke travels across rooms and builds up in poorly ventilated spaces. When restaurants and bars previously allowed smoking, it didn’t matter if you were one table away or across the restaurant, everyone was breathing in the smoke.

How do aerosols move throughout enclosed spaces, such as classrooms?

Classrooms are just like any other indoor space. If infected kids or adults are in the room, they will exhale aerosols with the coronavirus in them, and these aerosols will hang in the air, like smoke. The best things to do to prevent others from breathing in those virus aerosols are to wear masks and improve ventilation through filtration and opening windows.

What are some affordable ways teachers and school administrators can keep classrooms more safe for students?

There are a number of low-cost steps that schools can take to clean the air and reduce transmission of COVID-19.

  1. All students and adults should wear masks indoors at all times, since respiratory aerosols are released through breathing. Masks reduce the amount of aerosol released to the room by someone infected (including those that are asymptomatic) and also reduce the amount of aerosol breathed in by someone else (reducing the chance of infection). Mask fit is important, with the mask sealing against your face without gaps (i.e., not leaking) for best protection. KF94, KN95 and N95 masks are readily available and provide an even higher level of protection than cloth and surgical masks by removing greater than 90% of aerosols exhaled by others when you breathe in.
  2. Eat outdoors, and in inclement weather, have students eat in individual, well-ventilated classrooms, rather than large cafeterias, to reduce the number of students exposed to an infected individual.
  3. Improve ventilation, which can be as cheap as opening a window. Steps beyond just opening a window are to use fans to bring fresh air in and push dirty air out. Improving ventilation has the added side benefit of improving cognitive function by decreasing carbon dioxide buildup.
  4. Lastly, a cool do-it-yourself option is to make a Corsi-Rosenthal Cube, which is a box fan with 5 MERV-13 furnace filters duct taped together and can be made for less than $100. Research shows that these filters decrease aerosol levels, and they are being used in numerous schools nationwide. There are also commercial HEPA air filtration units available that cost more. There should be at least one HEPA air filter/cube in each classroom and multiple filters/cubes in any larger indoor spaces. Portable HEPA air filters supplement HVAC MERV-13 filters by filtering air immediately around students.

Do not buy ionizers, ozone generators or any products claiming to use ions/chemicals to remove virus particles. We, in the indoor air community, have been trying to raise the alarm about this, but unfortunately many individuals and school districts have wasted a lot of money on products that do not effectively remove virus aerosols, but do introduce other harmful gases. HEPA and MERV-13 level filtration is the best option for aerosol removal, as used in hospitals.

How can teachers or school administrators monitor indoor air quality and know if a room may have high aerosol concentrations?

A carbon dioxide monitor (about $250) will tell you how much exhaled air has built up in a room. With good ventilation, carbon dioxide concentrations indoors and outdoors should be similar (about 420 ppm). If the carbon dioxide levels reach higher than 800 ppm, that means that the room is poorly ventilated and that you are rebreathing the air that someone else has exhaled. This calls for the need for increased ventilation (opening a window to mix in outdoor air) and adding an air filtration unit to remove exhaled aerosol.

How will what we’ve learned about the transmission of COVID through aerosols impact how we handle other diseases such as the flu or the common cold?

What we’ve learned about aerosol transmission of COVID can greatly improve how we handle many other airborne respiratory diseases, like influenza, and improve our health overall. By improving indoor ventilation, we will reduce respiratory disease transmission, reduce exposure to air pollution and allergens like pollen, and improve cognitive function (by reducing exposure to high levels of carbon dioxide). In many countries even before COVID-19, it is customary to wear a mask when sick to prevent infecting others.

We have received public health guidance to social distance—what does this mean in the context of airborne transmission?

Just like standing next to a smoker, there is more exhaled aerosol close to a person, such that social distancing reduces exposure, particularly to droplets. However, aerosols travel across rooms, much farther than 6 feet, and build up in poorly ventilated spaces. Another way to think of it is—if you are in a pool and someone pees in it, you don’t want to stay in the pool, even if you are more than 6 feet away from them. This is why masking and ventilation indoors are so important, in addition to social distancing.

What’s the difference between exhaled droplets and aerosols?

Droplets are emitted during coughing and sneezing and are approximately the diameter of a human hair (100 times larger than aerosols). Droplets stay in the air for only a few seconds while traveling up to 6 feet of distance. Since the early 1900s, most doctors thought that infectious diseases spread primarily via droplets and surface contact. This was in part because droplets and surfaces are easier to measure.

Over the course of this pandemic, we’ve come to realize that this thinking was outdated. Aerosols can stay in the air for hours in poorly ventilated indoor spaces and can infect people across rooms that breathe in the previously exhaled aerosols. There is now overwhelming evidence that aerosols are how COVID-19 is transmitted.

What is the riskiest part of the school day for COVID transmission?

The riskiest part of the school day is anytime students are indoors and unmasked together. For students wearing masks, this risk occurs when eating lunch or snack. When multiple cohorts (classrooms) of students are together in a cafeteria/lunchroom, this increases the number of students exposed to an infected individual, since the aerosols travel across the entire room, far beyond 3-6 feet. Outdoor eating is the best solution, but with inclement weather, the next best solution is for small cohorts to eat in well-ventilated classrooms to reduce the number of students exposed to each other, to prevent outbreaks.

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The Centers for Disease Control and Prevention (CDC) issued an alert to doctors and parents about a rare respiratory disease that is affecting children.

The virus, called Enterovirus D68 (EV-D68), has similar symptoms to influenza or the common cold, health officials said last week.

Other health officials say that while enteroviruses are very common viruses that affect 10 to 15 million Americans per year, EV-D68 is “less common than other types of enterovirus.”

“Healthcare providers and hospitals in several regions of the United States notified the Centers for Disease Control and Prevention (CDC) during August 2022 about increases in pediatric hospitalizations in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV) … upon further typing, some specimens have been positive for enterovirus D68 (EV-D68),” said the CDC on its website in a Sept. 9 alert.

The CDC said that parents should contact their child’s doctor if they experiencing difficulty breathing or if their symptoms worsen. They also called on people to contact a healthcare provider if the child has a sudden onset of limb weakness.

Children with asthma might have a higher risk for severe respiratory illness caused by EV-D68, officials said.

“EV-D68 can also cause acute flaccid myelitis, an uncommon but serious neurologic condition which mostly affects children and causes the muscles and reflexes in the body to become weak,” the agency says.

There are no available vaccines or therapies for any enterovirus, the CDC alert said. It is recommended that doctors provide supportive clinical management of enteroviruses and related rhinoviruses, including EV-D68.

Prior outbreaks of EV-D68—first discovered in California in 1962—occurred in 2014, 2016, 2018, and in 2020 to a smaller extent, according to the agency’s alert. Data shows that the median age of children who obtained emergency department or inpatient care in 2018 was 3 years old, the CDC said.

“However, all ages of children and adolescents can be affected,” said the CDC. “Children with a history of asthma or reactive airway disease may be more likely to require medical care, though children without a known history of asthma can also present with severe illness. EV-D68 in adults is less understood but is thought to be more commonly detected in patients with underlying conditions.”

The CDC issued several recommendations regarding the virus, including advising people to wash their hands often; avoid touching the eyes, nose, and mouth; avoid close contact with people who are symptomatic; cover a cough or sneeze; clean and disinfect frequently touched surfaces; and stay home when sick.

Jack Phillips

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Jack Phillips is a breaking news reporter at The Epoch Times based in New York.

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Overview

Legionellosis varies in severity from a mild febrile illness to a serious and sometimes fatal form of pneumonia and is caused by exposure to the Legionella bacteria species found in contaminated water and potting mixes.

Cases of legionellosis are often categorized as being community, travel or hospital acquired based on the type of exposure.

Worldwide, waterborne Legionella pneumophila is the most common cause of cases including outbreaks. Legionella pneumophila and related species are commonly found in lakes, rivers, creeks, hot springs and other bodies of water. Other species including L. longbeachae can be found in potting mixes. 

The bacterium L. pneumophila was first identified in 1977 as the cause of an outbreak of severe pneumonia in a convention centre in the USA in 1976. It has since been associated with outbreaks linked to poorly maintained artificial water systems.

The infective dose is unknown but can be assumed to be low for susceptible people, as illnesses have occurred after short exposures and 3 or more kilometres from the source of outbreaks. The likelihood of illness depends on the concentrations of Legionella in the water source, the production and dissemination of aerosols, host factors such as age and pre-existing health conditions and the virulence of the particular strain of Legionella. Most infections do not cause illness.

The cause

The causative agents are Legionella bacteria from water or potting mix. The most common cause of illness is the freshwater species L. pneumophila, which is found in natural aquatic environments worldwide. However, artificial water systems which provide environments conducive to the growth and dissemination of Legionella represent the most likely sources of disease. 

The bacteria live and grow in water systems at temperatures of 20 to 50 degrees Celsius (optimal 35 degrees Celsius). Legionella can survive and grow as parasites within free-living protozoa and within biofilms which develop in water systems. They can cause infections by infecting human cells using a similar mechanism to that used to infect protozoa. 

Transmission

The most common form of transmission of Legionella is inhalation of contaminated aerosols from contaminated water. Sources of aerosols that have been linked with transmission of Legionella include air conditioning cooling towers, hot and cold water systems, humidifiers and whirlpool spas. Infection can also occur by aspiration of contaminated water or ice, particularly in susceptible hospital patients, and by exposure of babies during water births. To date, there has been no reported direct human-to-human transmission.

Extent of the disease

Legionnaires’ disease is believed to occur worldwide.

The identified incidence of Legionnaires’ disease varies widely according to the level of surveillance and reporting. Since many countries lack appropriate methods of diagnosing the infection or sufficient surveillance systems, the rate of occurrence is unknown. In Europe, Australia and the USA there are about 10–15 cases detected per million population per year.

Of the reported cases, 75–80% are over 50 years and 60–70% are male. Other risk factors for community-acquired and travel-associated legionellosis include smoking, a history of heavy drinking, pulmonary-related illness, immuno-suppression, and chronic respiratory or renal illnesses. 

Risk factors for hospital-acquired pneumonia are recent surgery, intubation (the process of placing a tube in the trachea), mechanical ventilation, aspiration, presence of nasogastric tubes, and the use of respiratory therapy equipment. The most susceptible hosts are immuno-compromised patients, including organ transplant recipients and cancer patients and those receiving corticosteroid treatment.

Delay in diagnosis and administration of appropriate antibiotic treatment, increasing age and presence of co-existing diseases are predictors of death from Legionnaires’ disease.

Symptoms

Legionellosis is a generic term describing the pneumonic and non-pneumonic forms of infection with Legionella

The non-pneumonic form (Pontiac disease) is an acute, self-limiting influenza-like illness usually lasting 2–5 days. The incubation period is from a few and up to 48 hours. The main symptoms are fever, chills, headache, malaise and muscle pain (myalgia). No deaths are associated with this type of infection.

Legionnaires’ disease, the pneumonic form, has an incubation period of 2 to 10 days (but up to 16 days has been recorded in some outbreaks). Initially, symptoms are fever, loss of appetite, headache, malaise and lethargy. Some patients may also have muscle pain, diarrhoea and confusion. There is also usually an initial mild cough, but as many as 50% of patients can present phlegm. Blood-streaked phlegm or hemoptysis occurs in about one-third of the patients. The severity of disease ranges from a mild cough to a rapidly fatal pneumonia. Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure.

Untreated Legionnaires’ disease usually worsens during the first week. In common with other risk factors causing severe pneumonia, the most frequent complications of legionellosis are respiratory failure, shock and acute kidney and multi-organ failure. Recovery always requires antibiotic treatment, and is usually complete, after several weeks or months. In rare occasions, severe progressive pneumonia or ineffective treatment for pneumonia can result in brain sequelae.

The death rate as a result of Legionnaires’ disease depends on the severity of the disease, the appropriateness of initial anti-microbial treatment, the setting where Legionella was acquired, and host factors (for example, the disease is usually more serious in patients with immuno-suppression). The death rate may be as high as 40–80% in untreated immuno-suppressed patients and can be reduced to 5–30% through appropriate case management and depending on the severity of the clinical signs and symptoms. Overall the death rate is usually within the range of 5–10%. 

Response

Treatments exist, but there is no vaccine currently available for Legionnaires’ disease.

The nonpneumonic form of infection is self-limiting and does not require medical interventions, including antibiotic treatment. Patients with Legionnaires’ disease always require antibiotic treatment following diagnosis.

The public health threat posed by legionellosis can be addressed by implementing water safety plans by authorities responsible for building safety or water system safety. These plans must be specific to the building or water system and should result in the introduction and regular monitoring of control measures against identified risks including Legionella. Although it is not always possible to eradicate the source of infection, it is possible to reduce the risks substantially.

Prevention of Legionnaires’ disease depends on applying control measures to minimize the growth of Legionella and dissemination of aerosols. These measures include good maintenance of devices, including regular cleaning and disinfection and applying other physical (temperature) or chemical measures (biocide) to minimize growth. Some examples are: 

  • the regular maintenance, cleaning and disinfection of cooling towers together with frequent or continuous addition of biocides; 
  • installation of drift eliminators to reduce dissemination of aerosols from cooling towers; 
  • maintaining an adequate level of a biocide such as chlorine in a spa pool along with a complete drain and clean of the whole system at least weekly; 
  • keeping hot and cold water systems clean and either keeping the hot water above 50 °C (which requires water leaving the heating unit to be at or above 60 °C) and the cold below 25 °C and ideally below 20 °C or alternatively treating them with a suitable biocide to limit growth, particularly in hospitals and other health care settings, and aged-care facilities; and
  • reducing stagnation by flushing unused taps in buildings on a weekly basis. 

Applying such controls will greatly reduce the risk of Legionella contamination and prevent the occurrence of sporadic cases and outbreaks. Extra precautions may be required for water and ice provided to highly susceptible patients in hospitals including those at risk of aspiration (for example, ice machines can be a source of Legionella and should not be used by highly susceptible patients).

Control and prevention measures must be accompanied by proper vigilance on the part of general practitioners and community health services for the detection of cases. 

WHO makes available technical resources to support the management and control of legionellosis and advises Member States when specific queries are raised.

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A growing number of people are reporting signs of long COVID, a concerning trend where virus symptoms continue for months after initial infection. Not helping matters is the spread of BA.5, the highly transmissible Omicron subvariant which is evading immunity from vaccines and prior infection. "We do know for absolutely certain that there is a post-COVID syndrome," Dr. Fauci says. "Anywhere from 25% to 35%—or more—have lingering symptoms well beyond what you would expect from any post viral syndrome like influenza and others." Here are five signs you've already had COVID, according to Dr. Fauci. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

1

Fatigue

Woman suffering from stomach cramps on the sofa at home.

Woman suffering from stomach cramps on the sofa at home.

Dr. Fauci has warned about fatigue being one of the signs of post-COVID syndrome. "Many [patients] had only minor COVID-19 symptoms to start, and here they are months later saying, 'I can't return to work. I can't take care of my kids.' They struggle with symptoms like intense fatigue, shortness of breath, heart palpitations and cognitive impairment. Tied to that are anxiety and depression. They are understandably very frustrated," says Johns Hopkins pulmonologist Emily Brigham, MD

2

Shortness of Breath

Asian young woman feeling discomfort as suffering from heartburn holding chest with closed eyes and sitting with folded legs on couch at home.

Asian young woman feeling discomfort as suffering from heartburn holding chest with closed eyes and sitting with folded legs on couch at home.

Dr. Fauci has highlighted shortness of breath as another common sign of long COVID. "Some systematic reviews and studies have shown this to be more common in older patients. But in our practice, we are seeing it more common in younger patients," says Michael Ghobrial, MD, Medical Director of Respiratory Therapy and Pulmonary Rehabilitation for Cleveland Clinic's Medina Hospital. "It's more common in females compared to males. It's also more common in patients who have other comorbidities and patients who have been having significant disease."

3

Brain Fog

Vertigo illness concept. Man hands on his head felling headache dizzy sense of spinning dizziness,a problem with the inner ear, brain, or sensory nerve pathway.

Vertigo illness concept. Man hands on his head felling headache dizzy sense of spinning dizziness,a problem with the inner ear, brain, or sensory nerve pathway.

Long-term brain fog—where people have memory issues, trouble focusing, and more—is one of the more common symptoms of long COVID, Dr Fauci says. "There are thousands of people who have that," says Dr. Igor Koralnik, chief of neuro-infectious disease at Northwestern Medicine in Chicago. "The impact on the workforce that's affected is going to be significant."

4

Sleep Issues

young woman holding face in bed in the dark dealing with insomnia or poor sleep

young woman holding face in bed in the dark dealing with insomnia or poor sleep

Dr. Fauci has mentioned chronic, ongoing sleep issues as a sign of long COVID. "Sleep disorders are one of the most common symptoms that patients who suffer from post-acute sequelae of SARS-CoV-2 infection are having these days. So mainly what we are finding is that they complain from insomnia, fatigue, also brain fog, some of them present sometimes circadian rhythm disorders," says Cinthya Pena, MD, sleep specialist for Cleveland Clinic.

5

Muscle Aches

A man experiencing discomfort in his upper arm

A man experiencing discomfort in his upper arm

Ongoing muscle aches are another symptom of long COVID to be aware of, Dr. Fauci says. 

"One out of three people who are ill with COVID-19 will have unusual muscle pains. It's more common in adults aged 16-65 (41%) than children (15%) or those over the age of 65 (36%)," according to the ZOE Health Study. "Unusual muscle pains are most likely to occur alongside other symptoms. Across all ages, most of the time muscle pains happen alongside fatigue and sometimes with fever, feeling dizzy or light-headed and skipping meals."

6

How to Stay Safe Out There

Follow the public health fundamentals and help end this pandemic, no matter where you live—get vaccinated or boosted ASAP; if you live in an area with low vaccination rates, wear an N95 face mask, don't travel, social distance, avoid large crowds, don't go indoors with people you're not sheltering with (especially in bars), practice good hand hygiene, and to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

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If your treatment plan includes surgery, you should know that your recovery will be slower if you get pneumonia. Your medical team will take steps to prevent it, but you play an important role, too. Here’s what you need to know.

Image

Diagram of lungs with pneumonia - stock

What is pneumonia?

Pneumonia is an infection that causes inflammation in the tiny airways (bronchioles) and air sacs (alveoli) in your lungs. Normally the alveoli fill with air when you breathe, but when you have pneumonia, they have fluid and pus in them, so air has a hard time getting in and breathing becomes painful. Pneumonia is usually caused by bacteria, but it can also be caused by viruses, fungi and parasites.

Who is at risk?

Certain factors can increase your risk of pneumonia, including:

  • Age. Under age 2 or over age 65
  • Environment or occupation. Spending a lot of time in crowded places (military barracks, prison, homeless shelters or nursing homes); locations where you breathe in air pollution or toxic fumes; and places where you are exposed to birds/animals that carry pneumonia-causing germs (poultry processing plant, veterinary clinic or pet store)
  • Habits. Smoking, excessive alcohol consumption or using drugs that cause sedation (opioids, tranquilizers)
  • Medical procedures. Hospitalization, general anesthesia, surgery, being on a ventilator
  • Medical conditions that weaken your immune system (HIV, chemotherapy, long-term use of steroid drugs such as prednisone) or your ability to cough/swallow (head injury, stroke, Parkinson’s, asthma COPD).
  • Serious conditions such as diabetes, heart failure, sickle cell disease or liver or kidney disease

Vaccination to prevent pneumonia

If you are at high risk for pneumonia, your doctor may have already suggested you get vaccinated against pneumococcus bacteria, which can cause many illnesses, including pneumonia. Several vaccines are available. Check the Centers for Disease Control and Prevention’s (CDC) website for more information on types of pneumonia vaccines and who and when to get them. Other vaccines that may also help prevent diseases that can lead to pneumonia include Haemophilus influenzae type b (Hib) vaccine, pertussis (whooping cough), varicella (chickenpox/shingles), measles and influenza. Vaccination can help protect you if you have to be hospitalized in the future.

How does surgery increase my risk?

When you breathe in, your body warms and moistens the air, and mucus traps dirt and germs. The cilia (hair-like projections lining your airways) sweep dirt and germs toward your mouth, where they can be eliminated. General anesthesia and the endotracheal tube inserted in your throat during surgery can cause the normal secretions in your airways to thicken or dry up, preventing the cilia from doing their job.

What can I do?

Preventing germy mucus from collecting in your airways and causing pneumonia is important. The number one way to prevent the spread of infection is to wash your hands. Everyone should wash their hands before entering your hospital room (including staff), after using the bathroom, after blowing their nose or coughing, before and after eating, and whenever hands are dirty. In addition, experts recommend that patients also follow these steps, represented by the acronym I COUGH.

Image

I COUGH information on fighting pneumonia — Patient Ed

Incentive spirometer. When awake, use your incentive spirometer 10 times every hour. Your nurse will show you how. 

Deep breathing and coughing may be painful after abdominal surgery. If so, talk to your nurse about ways to control the pain so you can do your exercises.

Oral care. Removing germs from your mouth keeps them from traveling down your airway to your lungs. The inside of your mouth should be cleaned on a regular basis with a toothbrush or antiseptic rinse. Your doctor may give you a prescription mouthwash to use. Do NOT smoke or use tobacco products.

Understanding. Read and follow instructions from your healthcare team.

Get out of bed. As soon as your nurse says it’s OK, move to a chair or take frequent walks if possible.

Head of bed elevated. Keep the head of your bed at a 30 to 45 degree angle.

Watch for symptoms of pneumonia

Report any signs and symptoms of pneumonia to your nurse or physician.

  • Fever of 100.4°F (38°C) or higher (Older adults or people with a weakened immune system may have a lower than normal body temperature if they have pneumonia.)
  • Shaking chills, sweating
  • Cough, usually producing mucus
  • Chest pain (may get worse when coughing or taking a deep breath)
  • Shortness of breath, painful breathing or rapid breathing
  • Fatigue
  • Gastrointestinal symptoms, such as loss of appetite, nausea, vomiting and/or diarrhea
  • Sudden change in mental status (older adults)

Treatment for pneumonia

If you develop pneumonia, your treatment will depend on the type, cause and severity of the pneumonia, and may include antibiotics, antiviral or antifungal medications. If your symptoms are severe or you are at higher risk of complications such as bacteremia (infection spreads into the bloodstream), lung abscess, kidney failure or respiratory failure, you may need to be treated in the hospital. Some people feel better within a week. For other people, it can take a month or more to recover from pneumonia.

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Stomach flu (viral gastroenteritis) is highly contagious. And you may be able to spread it before you know you're sick and for two weeks after you recover.

The term "stomach flu" is common, but this illness isn't related to the actual flu (influenza, a respiratory illness). Gastroenteritis is caused by several viruses, including norovirus and rotavirus.

This article looks at the causes and symptoms of stomach flu, how the viruses are spread, when viral gastroenteritis is contagious, and what you can do if you or someone in your household is sick with stomach flu.

Image Source / Getty Images

When Is Stomach Flu Contagious?

The contagious period is different depending on which virus causes the stomach flu.

  • Norovirus: Symptoms appear one to three days after exposure. You're contagious as soon as symptoms develop and for up to two weeks after you feel better.
  • Rotavirus: This virus is contagious even before symptoms appear and for up to ten days after you recover. Typically, symptoms start one to two days after exposure.

The typical recommendation is to return to daily activities only after you've been symptom-free for 24 hours. You're likely still contagious at that point, so preventive measures are important to keep from spreading it.

With both of these viruses, children are contagious for a longer period than adults.

Vaccinating Children

Rotavirus can be very serious and even deadly in younger children. You may want to ask your child's healthcare provider about a vaccine that prevents it.

Symptoms of Stomach Flu

Common stomach flu symptoms include:

  • Diarrhea, which is sometimes severe and watery
  • Vomiting
  • Nausea
  • Stomach pain
  • Fever
  • Headache
  • Body aches
  • Loss of appetite
  • Dehydration

Preventing dehydration is important, as you lose moisture through diarrhea, vomiting, and sweating due to a fever.

How Stomach Flu Spreads

Stomach flu is spread through contact with an infected person's stool or vomit. Common routes of infection for viral gastroenteritis are:

  • Sharing eating utensils
  • Eating improperly prepared foods
  • Drinking contaminated water
  • Kissing someone who is sick
  • Shaking hands with someone who is sick

You can also catch it by touching a contaminated surface and then touching your mouth or something you put in your mouth. This is called fomite transmission.

Stomach Flu Prevention

To prevent the spread of viral gastroenteritis, you should:

  • Wash your hands after using the bathroom or changing diapers, before and after preparing food, or when caring for someone who is sick.
  • Use hand sanitizer when soap and water aren't available or in addition to hand washing.
  • Thoroughly wash fruits and vegetables. To be extra safe, peel them.
  • Cook food thoroughly.
  • Don't allow sick people to prepare food or take care of others.
  • Thoroughly clean and disinfect high-touch surfaces (countertops, doorknobs) and anything the sick person has touched.
  • Wash linens and clothing the sick person has used.
  • Try not to touch your mouth or face, and teach your children not to touch theirs (or yours).

Staying away from sick people and keeping yourself and your sick family members home can help keep stomach flu from spreading, as well.

Summary

Stomach flu (viral gastroenteritis) is caused by viruses like norovirus and rotavirus. Symptoms include nausea, vomiting, diarrhea, stomach pain, fever, and weakness.

Stomach flu may be contagious for a couple of days before you have symptoms and up to two weeks after symptoms have cleared.

The virus is spread by direct or indirect contact with a sick person's stool or vomit. This includes kissing or touching a sick person or coming into contact with contaminated objects, surfaces, or food.

To prevent the spread, isolate, wash your hands, cook food thoroughly, and disinfect items the sick person has touched.

A Word From Verywell

The stomach flu is unpleasant, but people recover without any complications. If you or someone you care about seems to be especially sick or symptoms linger for longer than expected, talk to your healthcare provider.

Meanwhile, being smart about cleanliness and limited contact can go a long way toward keeping the virus from spreading.

Frequently Asked Questions

  • Is stomach flu contagious through air? Or through saliva?

    Yes, stomach flu can be spread through the air or saliva, especially soon after someone vomits. Then, as they breathe, sneeze, or cough, particles may carry the virus to you. You may also catch it from kissing and sharing utensils.

  • How long should I stay home from work with the stomach flu?

    People can generally return to normal activities once they are symptom-free for 24 hours. Depending on the cause of the stomach flu, you could still be contagious for up to two weeks after symptoms have cleared.

  • Does COVID-19 cause a stomach flu?

    No, but it can cause digestive symptoms such as nausea, vomiting, and diarrhea. Unlike the stomach flu, COVID also causes breathing problems, sore throat, cough, and the loss of taste or smell.

    A COVID test can help you figure out what's causing your digestive sypmtoms.

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Health Benefits Of Tulsi: A Tulsi plant in the balcony of the house is not only religiously approved but in Ayurveda it is considered a boon for health. A person can get rid of many diseases by consuming Tulsi leaves daily. Let’s know about these few benefits of consuming Tulsi leaves.

Remove bad breath
Bad breath is removed by cleaning teeth by mixing dry leaves of Tulsi with mustard oil. Apart from this, chewing Tulsi leaves also gets rid of problems like bad breath and pyorrhea.

sore throat
A decoction of Tulsi leaves can be used to relieve sore throat.

Breathing problem-
A decoction made by mixing honey, ginger and basil relieves bronchitis, asthma, cough and cold. A decoction made with salt, cloves and basil leaves also gives relief in influenza.

heart disease-
Tulsi helps to keep heart diseases at bay by reducing cholesterol levels in the blood.

stress-
Tulsi has anti-stress properties. Consuming Tulsi leaves also removes stress. To keep stress away, a person should consume 12 leaves of Tulsi twice a day.

transition –
Chewing a few leaves of Tulsi daily reduces the risk of infection. Ringworm, itching and other skin problems can be relieved by applying Tulsi extract on the affected area for a few days.

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The resurgence of Covid-19 in some countries including Sri Lanka, and the seasonal influenza virus circulating across the world has led to a surge in respiratory infections, prompting the chest physicians to urge those susceptible to developing respiratory infections to take precautions against them without delay.

Here, Consultant Respiratory Physician, District General Hospital and District Chest Clinic Trincomalee, Dr. Upul Pathirana explains what causes many of these infections, how to treat them and most importantly how to avoid them with easy to follow simple hygienic measures.

Excerpts

Q: Pulmonary infections such as pneumonia are now on the rise across the world. Of these infections what are the most serious diseases associated with pulmonary infection that you find in Sri Lanka and what part of the body is affected by them?

A. The infections hit on the respiratory system starting from nose to lungs and pleura. The medical community names these infections based on the anatomical sites and involved organisms. Covid-19 pneumonia is one of our concerns since December 2019 and there is a resurgence of Covid-19 in some countries including Sri Lanka. Seasonal influenza virus is circulating all over the world and it is one of the concerns for us as well.

Q: Can anyone get respiratory infections?

A. There are people who are susceptible to develop respiratory infections even though any of us can catch such infections. Individuals with risk factors are prone to develop severe infections and complications; otherwise it might be an acute simple self-limiting disease in most of the healthy persons.

Q: As Pneumonia is one of the most critical and common of these infections what exactly is pneumonia?

A. There is a spectrum of bugs including viruses, bacteria, fungi and parasites, which can cause respiratory infections. We call it pneumonia when affecting the air sacs (alveoli) within the lungs. Uncomplicated infections such as rhinitis and pharyngitis (affecting the nose and pharynx respectively) are more common than pneumonia.

Q: Are there different types of pneumonia? If so, name the most common in this part of the world?

A. We classify pneumonia based on the site involved within the lungs, causative factor, involved organism, acquired environment and many more. Microorganisms might not be the source of pneumonia in some instances but it might be following recurrent and long-standing exposure to some environmental particles at your home or working environment. Rarely, our own immune system stands against body tissues and gives rise to pneumonia, which needs specific treatment guided by a respiratory physician. Either bacteria or viruses cause by far the commonest pneumonia and it is acquired from the community in most cases.

Q: Is it contagious? How?

A. Even though the human-to-human transmission is well recognised in pneumonia, there is no evidence to say that this is true for all types of pneumonia. Most of the viral pneumonias spread rapidly within the community through air, droplets and/or contact routes. Pulmonary tuberculosis is one form of pneumonia with distinct features and it passes on to others from an infected person who has active disease.

Q: If air-borne what is the distance that the virus travels if one is in the same room when he or she coughs or sneezes?

A. This is a bit complex and technical topic and I will simplify for better absorption. The respiratory infections are transmitted through particles of different sizes. The particles could be either more than or less than 5 μm and they are called respiratory droplets and droplet nuclei respectively.

Droplet transmission occurs when a person is in in close contact (within 1 m) with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mucosa (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets.

Airborne transmission is different from droplet transmission as it refers to the presence of microbes within droplet nuclei, which can remain in the air for long periods of time and be transmitted to others over distances greater than 1 m.

Q: What precautions should one take to prevent getting infected?

A. The source control is one of the best strategies to minimie or prevent respiratory infections. Practicing hand hygiene is a simple yet effective way to prevent infections. A person with symptomatic illness has the potential to infect others even though an infected asymptomatic individual also spreads the disease. Therefore, if you have flu-like symptoms or any other respiratory symptoms, wear a facemask to cover your mouth and nose. The Centres for Disease Control and Prevention (CDC) also recommend sneezing into a disposable tissue, and then throwing it away and washing your hands clean. However, if you can’t access a tissue in time, sneezing into your elbow is the next best option to sneezing into the air.

Q: Can you give us a simple demonstration of these rules?

A. l Bury your mouth and nose in your inner elbow.

lSneeze, and then wait a few seconds to see if there is another sneeze on the way.

lIf you touch your sleeve, wash your hands before touching anyone or anything.

Q: Are respiratory infections curable?

A. The vast majority of respiratory infections are self-limiting or settle with symptomatic treatment as they are viral in origin. However, for pneumonia regardless of viruses or bacteria, you should seek medical advice early as timely intervention can cure pneumonia in most cases.

Q: Is it fatal especially if it affects the lungs?

A. Yes. Pneumonia is one of the most serious infections that affect humans. One suffering from pneumonia may develop complications like respiratory failure or septic shock (a state of low blood pressure) necessitating Intensive Care Unit (ICU) treatment. Mortality is high in severe complicated pneumonia all over the world.

Q: How do you prevent it?

A. Respiratory hygienic measures such as good hand hygiene, protective facemask, and avoiding sneezing or coughing in crowded places minimise the spread of infection. BCG vaccine administered to all newborns prevents complications of Tuberculosis in early childhood. Influenza and Pneumococcal vaccines can prevent influenza and pneumococcal pneumonia. There are many more to discuss about preventive measures and it is beyond the scope of this article.

Q: Who are those most at risk of getting it? Why?

A. Any of us can catch respiratory infections although individuals with risk factors are prone to develop more severe infections and complications. Uncontrolled blood sugar is one of the commonest reasons to acquire any type of severe infections including pneumonia. Less ambulatory people, patients with neurological disorders and other organ failures, cancer patients, chronic lung disease, people living with Acquired Immunodeficiency Syndrome (AIDS), malnutrition and those on medications which impair the immune system are at most risk.

Q: What about persons with underlying lung diseases including cystic fibrosis, asthma, or chronic obstructive pulmonary disease (emphysema)?

A. The patients with chronic lung diseases are at risk of acute exacerbations of their underlying lung disease due to respiratory infections.

Q: Those who have had a recent viral upper respiratory tract infection including influenza- are they too vulnerable?

A. Yes, although these infections look very simple, they can damage the surface of the wind tubes (airway epithelium) favoring adhesions and establishment of secondary bacterial infections.

Q: What are the symptoms to look out for?

A. Runny nose, sneezing, nasal block, sore throat, painful swallowing, cough and fever are the commonest of upper respiratory tract infections. When the organisms reach the lungs causing pneumonia, the patients develop high swinging fever, productive cough with yellow or rusty sputum, reduced appetite, chest pain during breathing and breathlessness. Extremes of ages such as elderly people can have unusual presentations like confusion as the sole manifestation of pneumonia.

Q: Who should patients with any of these symptoms consult initially?

A. A consultation with your family doctor is enough in most cases. However, if you are sicker, you can straight away seek institutional care from a hospital. Those with risk factors should consult a doctor as early as possible.

Q: How is it detected?

A. The doctors make the initial diagnosis after listening to the patient and carrying out physical examination. Initial blood investigations, sputum testing and chest x-ray in selected cases will confirm the diagnosis.

Q: Who makes the final diagnosis? What is the procedure involved?

A. After assessing the patient, the doctor will direct you for either home based care or institutional care. An experienced physician attends to all the pneumonia patients and decides the level of care such as in-ward or Intensive Care Unit.

Q: What tests are required for the patients to undergo? Why are they necessary?

A. The objectives of testing are to first confirm the pneumonia and then identify the causative organism. These patients might undergo further investigations to catch complications and to monitor the disease course and treatment. The investigations include sputum testing, blood investigations, imaging like X-ray, ultrasound and Computed Tomography. In selected cases, fibro optic bronchoscopic examination and sampling will be helpful.

Q: What are the complications (short term and long term) of Pneumonia?

A. Pneumonia affects your lungs through which the oxygen from the environment is entering your blood. Therefore, the oxygenation can be failed when the pneumonia is severe and it is called respiratory failure. Due to the effect of toxins produced by the involved microorganisms and our own body’s reaction to infection could create a state of low blood pressure called septic shock. There are other complications like lung abscess and pleural effusion (fluid between lung and chest wall). Despite the fact that even severe pneumonia can recover completely without any long-term consequences, some patients can have persistent residual lung damage.

Q: How do you treat pneumonia?

A. The mainstay of treatment is antibiotic and antiviral therapies. They need other supportive care for overall management.

Q: Is the treatment given tailored to the needs of the patient? Or is it a blanket treatment for all?

A. One size fit for all theory has now moved away from the medical practice. All the treatments are individualised in pneumonia patients as directed by an experienced physician.

Q: What is the usual recovery period?

A. There is no black and white answer in the form of number of days for recovery period. The recovery is quick within a few days in some cases and others it is prolonged.

Q: Do you have a message for our readers on avoiding risks of pneumonia? Any Do’s and Don’ts they should follow?

A. Good respiratory hygiene will protect you and those around you. If you are infected with a respiratory infection, act responsibly to prevent transmission of infection to others. Be alert and if there are alarming symptoms such as breathlessness consult a doctor early. Regular treatment under the supervision of your family doctor or relevant specialty doctor for those who have chronic diseases can reduce the morbidity and mortality associated with respiratory infections. Diabetes is a common disease in our country and those with uncontrolled blood sugar are at risk of complications including severe respiratory infections. Therefore, you should make sure that you periodically check blood sugar and keep it well controlled.

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I am a private person. I rarely write about my personal life in our syndicated newspaper column or on this website, but today I will tell you that I had polio when I was a child. As a result, I spent weeks immobilized and in traction in the polio ward at the Children’s Hospital of Philadelphia. I watched children all around me dying. This traumatic experience makes me disappointed with all the negative comments I have read about the COVID vaccine on our website and in the media. Even more worrisome, though, is the growing anti-vax movement in America. Has this opened the door to horrible diseases? Specifically, are we now more vulnerable to polio?

The Polio Story:

Most Americans have no idea what it’s like to suffer from polio, aka poliomyelitis. This is a disabling and life-threatening disease. It is caused by a virus (poliovirus). Like COVID, many people would not be aware that they caught the virus. Symptoms can be mild, a little like influenza. But the poliovirus can also invade the brain and spinal cord. That means it can paralyze the leg muscles, making it impossible to walk.

In more severe cases, the nerves and muscles that control speaking, swallowing and breathing can be affected. Perhaps you have seen pictures of children in iron lungs. Without that breathing support they would die.

Much has been written about long COVID. People experience overwhelming fatigue, joint and muscle pain, shortness of breath, brain fog, dizziness upon standing, neuropathy, sleep difficulties and depression to name just a few of the complaints we have read about.

Post polio syndrome symptoms include overwhelming fatigue, muscle weakness, brain fog, breathing problems, sleep disturbances and muscle and joint pain. Sound familiar?

Post Traumatic Stress Disorder!

There is one more thing. I still suffer from PPTSD. Most people might read that as post-traumatic stress disorder. I call it post polio traumatic stress disorder.

As a child I was ripped away from my parents and put in an isolation ward. My parents could visit once a week for an hour. Even then, they could not come close to me. They could peer at me from a tiny window in the door at the end of the isolation ward.

The nurses would point to the two distraught faces in that window and tell me to wave to my parents. That was it! No physical contact. No comforting words. I could not move because I was in traction with ropes and pulleys stretching my legs. And everyone around me stayed far away and wore white gowns and masks. Imagine what that would be like as a three-year-old.

During my teenage years I had nightmares about my hospital experiences. During the day, though, I tried to suppress all memories of polio. I could not run as fast as my classmates, but I sure tried hard to keep up and overcome any handicaps. I refused to be vulnerable to polio or its aftermath. If I fell, I jumped right up and pretended that nothing had happened, even if I was in pain.

Today, I can walk and even play tennis, but my legs still show signs of nerve damage. And I live in fear of someday developing post polio syndrome. I am still vulnerable to polio. Most people are oblivious.

Could Polio Return?

In 1979 the US eradicated polio. This viral disease has been all but eliminated from most of the world. Pakistan and Afghanistan are the remaining exceptions.

Now, however, a case of paralyzing polio has been diagnosed in New York. The young adult affected had never been vaccinated.

Are Americans Vulnerable to Polio?

More worrisome than one case of paralyzing polio is the discovery that polio virus is in wastewater samples in neighboring New York counties. This suggests that the virus may be spreading in several communities. The State Health Commissioner of New York warned that hundreds of people could already be infected.

A surprising number of children and adults have not been vaccinated against polio, even though the shots are 99% effective in kids. Only 79% of young children in the state of New York have been vaccinated against polio. That is scary, but it may be due in part to COVID disrupting routine health care. However, in Rockland County, New York, the vaccination rate is roughly 60%. Are these kids vulnerable to polio? You bet!

The New York Health Commissioner is encouraging people who have not been vaccinated against polio to get their shots immediately. Are Americans so skeptical that they have given up on vaccinating against this devastating disease that can lead to disability and death?

We Are Skeptics Too!

Anyone who has read our work for the last 44 years knows that we have been tough on drug companies. We have also raised hard questions about the effectiveness of influenza vaccines at this link.  When we learned that lasting shoulder pain was a problem due to flu shots, we advised people about the Vaccine Adverse Event Reporting System (VAERS)  (800-822-7967) and the National Vaccine Injury Compensation Program (800-338-2382).

We are neither vaccine enthusiasts nor vaccine cynics. We seek data and do our best to report research objectively. But because I have had polio, I can tell you that vaccines save lives and prevent untold misery. Most vaccine skeptics never had to live with polio. Why are we vulnerable to polio in the 21st century?

The Polio Vaccine:

When Dr. Jonas Salk announced on April 12, 1955, that the polio vaccine was effective, parents rejoiced. That’s because the polio virus had been responsible for paralyzing or killing hundreds of thousands of children. Some people had to spend their lives in “iron lungs” because they could not breathe on their own. Imagine living your life inside a machine.

Dr. Salk’s heroic vaccine trial of 1954 included a million youngsters around the country. Prior to its development, parents would try to keep children inside and away from swimming pools during the summer for fear of the infection. Sometimes quarantines were imposed and travel between cities was restricted.

Within a few years after it became available, the polio vaccine had reduced infections to fewer than 6,000 annually. Life returned to normal and children were allowed to be children again.

Let’s Not Be Vulnerable to Polio Ever Again!

On August 11, 2022 Dr. Jose Romero of the CDC told CNN that the New York polio case is:

“…just the very, very tip of the iceberg.

“There are a number of individuals in the community that have been infected with poliovirus. They are shedding the virus. The spread is always a possibility because the spread is going to be silent.”

I hope Dr. Romero is wrong! I hope that that the man with paralyzing polio recovers completely and no one else is affected. I do not want any child to go through what I experienced so many years ago.

The doctors told my mother that I would need braces for my legs and that I would never walk normally. She massaged my legs daily for hours. It took me a long time before I could walk again. The experience left lasting scars, but I was one of the lucky ones. I survived.

A small favor please. Do you know someone who is anti-vaccines? Perhaps my story will change their minds. Please scroll to the top of the page and send this article to friends and family who are anti-vaxers. I do not want to see polio return!

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  Common Cold  Asthma Attacks
Breathing problems Common, usually mild with nasal and sinus congestion Common, usually severe with shortness of breath, wheezing, and difficulty breathing
Cough Common, sometimes with phlegm Common, often dry (hacking) but occasionally wet (with phlegm)
Nasal problems Common, including runny nose, sneezing, post-nasal drip, and congestion No
Throat pain Common, usually with mild sore throat Common, including throat tightness, hoarseness, or irritation 
Fever Common, usually mild Uncommon
Headache Common Uncommon
Body aches Common, usually mild muscle and joint aches No
Chest pain Occasional, mostly due to prolonged coughing Common, including chest pain and tightness

Timing of Symptoms

With viral-induced asthma, the symptoms of a cold typically come before an asthma attack. At that point, both the upper and lower respiratory tract become affected.

This means the sneezing, coughing, headache, and nasal congestion of a cold triggers asthma symptoms (wheezing, shortness of breath, and chest pain). If a cold develops rapidly, the cascade of symptoms may occur all at once.

With viral-induced asthma, you may have symptoms that are uncommon in either disease, including high fever and chills. This typically happens when there's a secondary infection of the lungs, such as bacterial pneumonia.

Cold and Asthma in Toddlers

Colds, even recurrent colds, do not "cause" asthma. However, babies and toddlers who experience severe respiratory infections are more likely to develop asthma than those who do not.

Diagnosis

The overlap of symptoms in people with viral-induced asthma can make diagnosis difficult.

Healthcare providers easily recognize classic cold symptoms. But asthma-related wheezing, shortness of breath, and chest pain can be caused by other diseases, such as severe bronchitis or pneumonia.

Diagnosing viral-induced asthma requires a thorough review of your symptoms and medical history along with a physical exam and other diagnostic tests.

Diagnostic Work-Up

A diagnosis of viral-induced asthma typically requires some detective work. As part of the work-up, the healthcare provider will want to know:

  • Current symptoms, what happened before them, and which came first
  • Your history of respiratory infections
  • Your family history of chronic respiratory illnesses
  • Your smoking history
  • Any chronic illnesses you have, such as chronic obstructive pulmonary disease COPD or congestive heart failure

A physical exam includes an evaluation of your breathing with a stethoscope. Apart from wheezing, other breath sounds may add to evidence for the cause of your condition. Wheezing is considered one of the defining features of asthma. Any accompanying sounds may suggest which type of virus is involved.

Seasonal Changes With Colds and Asthma

Respiratory infections in early fall are more likely due to a rhinovirus. Those occurring in winter are more likely due to influenza or RSV. These factors, along with age, can make a difference in how your healthcare provider diagnoses and treats your condition.

Lab and Imaging Tests

If your symptoms are severe and your healthcare provider detects abnormal breathing sounds, they may order blood tests to check for viral pneumonia, RSV, influenza, or COVID-19.

Common tests include:

Blood tests for rhinovirus or adenovirus are also available, but because treatments aren't available for them, the tests are used less often.

Pulmonary function tests (PFTs) can evaluate how well your lungs are functioning during and after an acute attack. If tests show both a respiratory infection and decreased lung function, it's a strong indicator that you have viral-induced asthma, especially if your asthma is well-controlled.

Allergen testing may be useful in diagnosing allergic asthma, but it does not necessarily exclude viral-induced asthma as a cause. Given how common viral-induced asthma is, some findings warrant treatment even if the specific virus isn't identified.

Treatment Without Diagnosis?

You may be treated for asthma-like symptoms during a viral illness even if you're not formally diagnosed with asthma. They symptoms may be labeled "reactive airway" instead.

How Do You Treat a Cold With Asthma?

Asthma medications will never fully prevent or relieve asthma symptoms induced by a cold or other respiratory illness. That's because they produce different kinds of cytokines, and asthma drugs only treat some of them.

Breathing difficulties may persist as the inflammation in both the upper and lower respiratory tracts feed on each other. Symptoms will continue until the viral infection is resolved.

This is especially true when eosinophils are produced in excess. This can lead to a condition known as eosinophilia, in which the eosinophil build-up causes inflammatory damage to the airways. It's this sort of damage that can increase the risk of severe illness, including pneumonia, in people with viral-induced asthma.

Medications

If a cold is a trigger for an attack, the resolution of the infection (which usually happens within two weeks) will usually improve breathing problems as well.

Still, the standard treatment of a cold or flu should be accompanied by the appropriate use of asthma medications. This may include the increased use of a short-acting beta-agonist (also known as a rescue inhaler).

According to the National Heart, Lung, and Blood Institute, a short-acting beta-agonist like albuterol can be used every four to six hours during a cold to reduce the risk of an asthma attack. Check with your healthcare provider to make sure this is safe for you.

Cold Treatment

  • Symptoms may be managed with decongestants, cough formula, antihistamine, and nonsteroidal anti-inflammatory drugs.

  • Nasal washing may help clear mucus build-up.

  • Flu may be shortened with the early use of antiviral drugs like Tamiflu (oseltamivir) and plenty of bed rest.

The use of antihistamines for viral-induced asthma is uncommon unless you have allergic asthma. Allergy medications relieve nasal congestion from a cold, but they tend to be less useful in treating viral-induced asthma as they have no effect on the virus itself.

Prevention

One of the best ways to avoid viral-induced asthma attacks is to avoid colds and other viral illness.

This is often easier said than done, particularly during cold and flu season or in families with young children. Cold viruses are easily passed by sneezing and cough or by touching surfaces contaminated with germs.

The Centers for Disease Control and Prevention (CDC) recommends the following measures for preventing viral illnesses:

  • Stay away from people who are sick.
  • Wash your hands frequently with soap and water for at least 20 seconds.
  • Avoid touching your face, nose, or mouth with unwashed hands.
  • Disinfect frequently touched surfaces and items, including counters and toys.

You may also want to wear a mask in public during cold and flu season, allergy season, or when COVID-19 cases are high in your area.

To further reduce the risk of viral-induced asthma, adhere to your daily asthma medications, taking them as prescribed and on schedule. If you have a history of severe viral-induced attacks, ask your healthcare provider if a short course of oral corticosteroids is reasonable.

You should also steer clear of secondhand smoke and other asthma triggers until the cold is fully resolved. If you are a smoker and cannot quit, ask your healthcare provider about smoking cessation aids (including nicotine patches and oral medications) to help you stop.

Preventing Asthma Attacks When You Have a Cold

The key to preventing asthma attacks during viral illnesses is having well-controlled asthma. If you use a rescue inhaler more than twice a week, talk to your healthcare provider about how to improve control.

Finding the right combination of asthma controller medications can significantly reduce your risk of an attack.

If you have a history of severe viral-induced asthma, speak with your healthcare provider about taking oral corticosteroids at the start of a cold. There's some evidence they can help, especially in people who need emergency care or hospitalization after a severe attack.

Getting Vaccinated

No vaccines can prevent a cold, but annual flu shots and the recommended COVID-19 vaccinations and boosters can help reduce your risk of illnesses that could trigger asthma attacks.

Summary

It's common for asthma get worse with a cold, or to have more severe cold symptoms due to your asthma. You may even have asthma only when you have a respiratory infection. Allergies and allergic asthma can exacerbate the problem, as well.

Having a cold and asthma together can make both of them harder to manage. Medications for both problems can help.

Prevention is important, so be sure to take your asthma medications as prescribed. You'll also want to avoid getting sick, so practice social distancing, wash your hands often, disinfect high-touch items and surfaces, and consider wearing a mask.

A Word From Verywell

If you find that a cold or flu triggers an asthma attack, let your healthcare provider know. This occurs more often than you might think, and it may mean you need more aggressive asthma treatment That's especially true if you're prone to respiratory infections.

Frequently Asked Questions

  • How do I manage a cold and asthma at night?

    Nocturnal asthma (worse asthma at night) is common. Both asthma and cold symptoms may be worse in the evening.

    Food, smoke, dust, and other triggers can lead to nocturnal symptoms. Be sure to keep your environment as irritant-free as possible.

    You may also want to take cold medicine intended for nighttime use.

  • How do you treat cold and asthma during pregnancy?

    It's important to control asthma during pregnancy because lower oxygen levels that can lead to low birth weight and other complications in the baby.

    Your healthcare provider can help you monitor asthma closely and prescribe pregnancy-safe medications.

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Elderberry is dark purple fruit from the elderberry shrub. It's a rich source of antioxidants known as anthocyanins.

Some claims about elderberry's benefits have more scientific backing than others. These include:

  • Treating the common cold and the flu (influenza)
  • Pain relief
  • Disease prevention

Traditional uses with less evidence behind them are for:

In addition to the fruit itself, you can get elderberry through commercial supplements in the form of gummies, lozenges, syrups, teas, and more.

In this article, you'll learn about the evidence behind elderberry's benefits and how to take it plus the possible side effects, drug interactions, and other potential dangers you should be aware of before using this fruit medicinally.

Verywell / JR Bee


Health Benefits

The European elder (black elderberry, Sambucus nigra) is the species most often used in supplements. Other elder species also produce anthocyanin-rich berries, as well.

Many of elderberry's health benefits are linked to anthocyanins. Some research suggests they may:

  • Clear your body of free radicals (unstable molecules that damage cells and may cause disease)
  • Have antiviral properties that prevent or reduce the severity of some common infections
  • Have anti-inflammatory benefits due to changing your body's immune response

Colds and Flu

Elderberry juice syrup has been used for centuries as a home remedy for viral illnesses like the cold and flu. Some researchers have concluded that this syrup shortens the duration of some illnesses and makes them less severe.

Some preliminary evidence from small studies appears promising.

  • In a 2019 study on elderberry for cold and flu, it appeared to greatly reduce upper airway symptoms.
  • A 2012 study suggested elderberry could help prevent influenza by stimulating an immune response.
  • A 2016 study on airline passengers suggested using elderberry extract for 10 days before and five days after a flight led to milder symptoms and 50% fewer sick days from the cold.

In the air travel study, while it appeared to lower the duration and severity of the illness, it didn't appear to prevent it. Both the elderberry group and placebo group had about the same infection rate.

Pain Relief

Anthocyanins are known to reduce inflammation. Those in elderberry do so by blocking nitric oxide production in your immune system.

Nitric oxide tells the immune system to cause inflammation, which is part of its response to illness or injury. Elderberry seems to slow down the inflammatory response, which may lower swelling and the pain it can cause.

Topical elderberry tinctures and salves have long been used in folk medicine to treat:

Few studies have investigated elderberry's anti-inflammatory or pain-relieving benefits in humans. Evidence should be considered preliminary.

Disease Prevention

Some alternative healthcare providers say elderberry's antioxidant effects can reduce your risk of cancer and heart disease.

While it's true that antioxidant-rich diets may offer such benefits, no studies have been done that directly link elderberry consumption to better disease outcomes.

Nutritional Data

One cup of elderberries provides:

  • 106 calories
  • 1 gram of protein
  • 27 grams of carbohydrate
  • 10 grams of fiber

When it comes to the recommended daily allowance of vitamins and minerals, a cup of elderberries contains:

  • Vitamin C - 58% 29% of the RDA
  • Vitamin B6 - 20%
  • Iron - 13%
  • Potassium - 9%

Possible Side Effects

Ripe, cooked elderberry fruit is considered safe to eat in moderation. As with several other fruits, eating a lot can cause:

  • Diarrhea
  • Stomach ache
  • Abdominal cramping

Poisoning

Elderberries should always be cooked before they're consumed. Certain parts of the plant contain a poison called known as cyanogenic glycoside—cyanide. It's in the:

  • Leaves
  • Roots
  • Bark
  • Stems
  • Unripe, raw berries

Unripe elderberries can release cyanide into your body and make you sick. Even ripe berries contain trace amounts, so elderberries must be cooked before you eat them.

Poisoning Symptoms

Poisoning from elderberries is rarely life-threatening. But it may cause:

Get medical attention if you develop these symptoms after consuming elderberry.

Who Shouldn't Take It

Elderberries may not be safe for some groups of people. No safety information is available about elderberry use:

  • In children
  • During pregnancy
  • While breastfeeding

Don't consume elderberries if:

  • You have an autoimmune disease
  • You've had an organ transplant
  • You're taking medication for diabetes

Drug Interactions

Elderberry products may interact with drugs that suppress the immune system and make them work less efficiently. Examples of these drugs are:

Forms and Dosages

Elderberries have long been cultivated for food and to make natural medicines. Products are available in many forms, including:

  • Syrups
  • Teas
  • Capsules
  • Gummies
  • Tonics
  • Tinctures
  • Topical ointments

The ripe berry is tart and typically sweetened (like cranberries).

For Cold and Flu Symptoms

Treatment should start no later than 48 hours after the first cold or flu symptoms appear. As a general rule, you shouldn't take more than what the manufacturer recommends on the label.

Many commercial syrup manufacturers recommend taking 1 tablespoon (15 milliliters) of elderberry syrup four times a day to treat cold or flu symptoms. Elderberry lozenges (175 milligrams) can be taken twice daily.

Keep in mind that elderberry should never be used as a substitute for conventional medical care. Self-treating a condition and delaying standard medical treatment may have serious consequences.

What to Look For

Elderberry-based medications are classified as dietary supplements by the U.S. Food and Drug Administration (FDA). Under this classification, they're not meant to be sold or marketed as a treatment for any medical condition.

Because supplements aren't required to undergo rigorous research or testing, they can vary significantly in quality. To ensure quality and safety, only buy supplements that are certified by an independent certifying body, such as:

  • U.S. Pharmacopeia (USP)
  • NSF International
  • ConsumerLab

This certification doesn't mean the product is effective, only that it's not contaminated and actually contains what the label says it does.

Safety Warning

If you eat fresh berries, be sure you buy them from a reputable source. It's never safe to eat unknown berries in nature, as they may have dangerous effects. If you have eaten an unknown berry and develop concerning symptoms, get immediate medical attention.

Summary

Elderberry is a fruit that's long been used in traditional medicine and appears to have some medicinal benefits. These include treating the cold and flu, relieving pain, and possibly helping prevent disease due to their antioxidant activities.

You can take elderberry supplements in several forms, including gummies, syrups, teas, and capsules. Don't eat unripened berries in any form, as they can make you sick. Ripe berries should always be cooked before consumption.

Frequently Asked Questions

  • What is elderberry most commonly used for?

    Elderberry is most commonly used as a cough syrup. Research suggests elderberry juice syrup may help treat upper respiratory symptoms of colds and flu.

  • Is it safe to take elderberry every day?

    Commercially made elderberry supplements shouldn't contain cyanide, so they're considered safe for daily use. Only take the amount recommended on the label.

    Use homemade elderberry syrup—sometimes marketed as artisan, handcrafted, or small-batch—with caution as it may contain small amounts of cyanide.  

  • How should I store fresh elderberries?

    Elderberries will keep longer if they're stored in the refrigerator.

  • How do you make elderberry syrup?

    1. Combine 2 cups of dried elderberries with 4 cups of cold distilled water in a heavy saucepan.
    2. Bring it to a boil, reduce heat, and cook uncovered for 30 to 40 minutes. Stir regularly.
    3. Remove from heat and steep for 1 hour. Strain mixture into a large measuring cup covered with cheesecloth, reserving liquid and discarding the used berries.
    4. Allow syrup to cool, then stir in 1 cup of honey. Pour mixture into a sterilized container.
    5. Seal and store in the refrigerator for up to three months.

    You can buy dried berries online and in health food stores.

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Researchers have developed a novel wrist-worn device that marks itself as a good candidate for detecting the symptoms of COVID-19 before they can actually occur. Although the technique is not new, researchers have utilized almost the same mechanism to detect the symptoms of influenza and the common cold as reported in research published last year. However, this new device has been specifically designed by incorporating an algorithm to detect the symptoms of COVID-19 a couple of days before they occur. It should be noted that the research work for this detecting device began in 2020 when COVID-19 was spreading like a wildfire.

The wristwatch, known as the “Ava Bracelet,” has been given to 1,000 young participants who participated in this continued research work. It is made to be worn at night and can detect “heart rate, breathing rate, skin temperature, heart rate variability, and blood flow” every 10 seconds. As the study completed its one-year, there was a lab-confirmed case of COVID-19 from the 11% population. Moreover, half of those COVID-positive patients wore the device at a much higher frequency, which ultimately assisted researchers in setting up an algorithm through the data gathered from these participants that can detect the infection as soon as it progresses into the body, even before the presence of any physical symptoms.

The researchers said, “Wearable sensor technology is an easy-to-use, low-cost method for enabling individuals to track their health and well-being during a pandemic. Our research shows how these devices, partnered with artificial intelligence, can push the boundaries of personalized medicine and detect illnesses prior to SO [symptom onset], potentially reducing virus transmission in communities. “

Coupled with this, the algorithm that was being designed after gathering data from the population under consideration was then trained on 70% of the COVID-positive group. The algorithm was then applied to 30% of the remaining population, and guess what? Through the algorithm, around 68% of infected patients were caught by this wearable device even two days before their symptoms started to appear.

According to David Conen, who is the author of this study, “That an existing medical device is able to be used in a different meaning [shows] that wearables have a promising future. This is not related only to COVID; in future diseases, it could also lead to preventative treatments and prevent significant complications. ” Apart from this, the team is now expanding their research and it was reported that they are implementing the procedure on about 20,000 people, the results of which are expected in the last quarter of this year.

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Queensland University of Technology (QUT) Professor Lidia Morawska will lead a new $5 million training centre to reduce airborne infections through improved indoor air quality for better public health  in new building systems.

The Australian Research Council (ARC) Training Centre for Advanced Building Systems Against Airborne Infection Transmission aims to reduce airborne infection transmission by improving indoor air quality while maintaining comfort and efficiency.

Morawska said researchers had been emphasising the need for a public health revolution in relation to indoor air quality for a long time.

“I firmly believe the centre will be a catalyst for revolution and bring us closer to clean indoor air becoming the norm,” Professor Morawska said.

“Our work will see Australian building system manufacturing companies, working alongside international companies, as forerunners in establishing the new norm.”

Morawska from the QUT School of Earth and Atmospheric Sciences in the Faculty of Science is director of the International Laboratory for Air Quality and Health (LAQH).

She said every year acute respiratory illnesses, such as colds and influenza, caused an estimated 18 billion upper airway infections and 340 million lower respiratory infections, resulting in more than 2.7 million deaths and billions of dollars in economic losses.

“Respiratory infectious diseases spread mainly by airborne transmission, which is the inhalation from the air of virus or bacteria-laden particles generated during breathing, speaking and all other human respiratory activities,” she said.

“Protecting building occupants from airborne infection in all shared interior spaces must be strategically controlled.

“This has never previously been envisioned outside specialised sections of health care facilities.”

Centre outcomes will include new intelligent building systems, improved building technologies, quantitative methods for building control, evidence for policymaking and recommendations for operational guidelines.

Wide-ranging benefits will include the reduced health and economic burden of inadequate indoor air and Australia’s increased competitiveness in the demand for next-level building systems.

The centre, to be located at QUT Gardens Point campus, will include international experts and partners from Australia, USA, Italy, Finland, China, The Netherlands, and Sweden.

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What if a fitness tracker sitting on your wrist could detect COVID-19 before you even developed symptoms? An impressive new study claims this is not only possible, but preliminary investigations found infections can be detected nearly 48 hours before symptoms appear.

The new research began in early 2020, soon after the pandemic kicked off. A team of researchers wondered whether data from a wrist-worm health tracker could be leveraged to pick up small changes in a person’s vital signs that precede the onset of COVID-19.

Around 1,000 young participants were recruited from an ongoing observational health study and supplied with a commercially available wrist-worn device known as the Ava bracelet. The device is worn at night and every 10 seconds it measured heart rate, breathing rate, skin temperature, heart rate variability and blood flow. It is generally used as a fertility monitor due to its ability for tracking real-time changes to these five health measures.

Over the course of a year-long study 11% of the cohort came down with a lab-confirmed case of COVID-19. Around half of those COVID-positive subjects had a month of good wearable data preceding their infection, helping the researchers develop an algorithm that can detect small changes across the earliest stages of illness.

Noticeable changes in the days before COVID symptoms appeared were detected across all five measures recorded by the wearable. In particular, changes to heart rate, heart rate variability and wrist skin temperature were the most significant early features of COVID-19, preceding noticeable symptoms.

A novel machine-learning algorithm was trained on 70% of the COVID-positive cohort and then tested on the remaining 30%. Remarkably, the algorithm accurately caught 68% of the positive COVID cases two whole days before any symptoms appeared.

“Wearable sensor technology is an easy-to-use, low-cost method for enabling individuals to track their health and well-being during a pandemic,” the researchers concluded in the new study. “Our research shows how these devices, partnered with artificial intelligence, can push the boundaries of personalized medicine and detect illnesses prior to SO [symptom onset], potentially reducing virus transmission in communities.”

The idea that health wearables could detect infectious diseases before any tangible symptoms appear is not new. A fascinating study published last year tested out the idea on influenza and the common cold.

That research actually infected several dozen young volunteers with either rhinovirus or H1N1 and then tracked several health measures using a fitness tracker over the following days. Not only did the study establish that infections could be predicted using wearable health data around 24 hours before symptoms appeared but the severity of the subsequent infections could also be predicted with around 90% accuracy.

David Conen, an author on this new COVID-detection study, said the potential for detecting infections by combining advanced algorithms with real-time health data from wearables is promising. His team is now conducting a larger study testing the COVID-detection system in 20,000 subjects. Results from that investigation are expected later this year.

"That an existing medical device is able to be used in a different meaning [shows] that wearables have a promising future," said Conen. "This is not related only to COVID, in future diseases, it could also lead to preventative treatments and prevent significant complications."

The new study was published in the journal BMJ Open.

Source: McMaster University



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Credit: Pixabay.

AI is touted as disruptive and transformative for a wide range of industries, but there’s perhaps no other field where it provides more value than healthcare. After all, what’s more valuable than a person’s life? Machine learning programs are now being used in many hospitals to spot cancer and other diseases and discover new drugs, but there’s still this general impression that this is all done at a small scale and the impacts are still minimal. The reality couldn’t be further from the truth. AI is already here to stay and it has already saved thousands of lives. Not tomorrow or at some distant point in the future. Now.

Researchers at Johns Hopkins University published two studies this week describing a machine learning-based early detection tool for sepsis that was deployed at five hospitals over a two-year period. During this time period, the AI was able to identify nearly 10,000 sepsis cases from patient records and helped doctors deliver critical care about two hours, on average, earlier than when they didn’t have access to the AI’s alert.

Thanks to this system, the patients were 20% less likely to die of sepsis, potentially saving thousands of lives across the U.S. if it is implemented nationwide. About 1.7 million American adults develop sepsis, and more than a quarter million die because of it.

“It is the first instance where AI is implemented at the bedside, used by thousands of providers, and where we’re seeing lives saved,” says Suchi Saria, founding research director of the Malone Center for Engineering in Healthcare at Johns Hopkins University, and lead author of the studies.

“This is an extraordinary leap that will save thousands of sepsis patients annually. And the approach is now being applied to improve outcomes in other important problem areas beyond sepsis.”

Sepsis happens when the immune system overreacts to an infection, causing damage to the body’s own tissues and organs. This out-of-control reaction can be very violent, triggering widespread inflammation in the body that is often life-threatening. The vast majority of sepsis cases are bacterial in origin, but other types of infections — including COVID-19, influenza, and fungal infections — are also known to cause sepsis.

Once sepsis sets in, the patient usually suffers fever, a rapid heart rate, and difficulty breathing. When treating sepsis, time is of the essence. Even a single hour of delay in proper treatment can be the difference between life and death.

However, sepsis is not always obvious, so there is naturally some delay in diagnosis and its symptoms can even be confused with those of other less serious infections. But if the condition is not diagnosed in time, it can progress into septic shock, causing a significant drop in blood pressure, organ failure, and widespread tissue damage. Even with treatment, in some cases, there is nothing doctors can do to save the patient’s life, which is why prevention is the name of the game with sepsis. During standard care, 30% of patients with sepsis die. Among them was Saria’s nephew.

“Sepsis develops very quickly and this is what happened in my nephew’s case,” she says. “When doctors detected it, he was already in septic shock.”

This is why the AI developed at Johns Hopkins, known as the Targeted Real-time Early Warning System, is so important. In the two years the system had been online since 2018, during which it monitored over 590,000 patients via their electronic health records, the AI was able to flag nearly 10,000 cases of sepsis. Its accuracy following diagnosis proved to be 38%, which might not sound like a lot, but earlier systems couldn’t achieve more than 12%.

More than 4,000 doctors used the AI for sepsis detection, which allowed them to detect the infection an average of nearly six hours earlier than traditional methods.

“This is a breakthrough in many ways,” says coauthor Albert Wu, an internist and director of the Johns Hopkins Center for Health Services and Outcomes Research. “Up to this point, most of these types of systems have guessed wrong much more often than they get it right. Those false alarms undermine confidence.”

This work showcases the power of AI in a healthcare setting to save lives — and this is just the beginning. Researchers at Johns Hopkins have already adapted the system to provide early warnings for patients at risk of bed sores, sudden deterioration caused by bleeding, acute respiratory failure, and cardiac arrest.

The findings appeared in the journals Nature Medicine and Nature Digital Medicine.

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Granulomatosis with polyangiitis (GPA) is a rare disease characterized by necrotizing vasculitis of small and medium-sized vessels plus granuloma formation. Clinical manifestations commonly involve both upper and lower respiratory tracts, as well as kidney dysfunction. Symptoms of nasal dysfunction, epistaxis, and pulmonary damage, characterized by infiltrates, effusions, and hemorrhage, are the most frequent. Although pulmonary involvement is the most common manifestation of GPA, diffuse pulmonary hemorrhage is a rare and potentially devastating sequela noted to be a cause of significant morbidity and mortality [1]. Prompt recognition and diagnosis of pulmonary hemorrhage are essential as it can lead to hypoxemia, acute respiratory distress syndrome, and eventually, respiratory failure requiring respiratory support [2]. There are few reports in the literature that describe challenges with endotracheal intubation secondary to airway stenosis and mucous plugs, and even fewer describe management in their presence. This is concerning as mucous plugs, present in regions of airway narrowing in the tracheobronchial regions, can lead to critical airway obstruction, which was highly suspected in our case [3]. While there is little published about airway management in the setting of GPA, there is even less reported about the diagnosis of GPA in children. Clinicians need to maintain a very high index of suspicion when caring for patients, especially children, with respiratory distress.

A previously healthy 10-year-old African American female presented to a community hospital emergency department accompanied by her mother for worsening shortness of breath, epistaxis, and cough over the previous week. The child is up-to-date on her childhood vaccinations and has no medication allergies. There were also no reported familial health conditions at this time. She further reported that no one in the family is vaccinated for COVID-19 and that the child does attend in-person schooling. Her mother also added that the child has been experiencing intermittent epistaxis for the past 48 hours, which was managed with direct pressure and one episode of "crying blood," which resolved on its own.

Her vital signs were remarkable tachycardia with a heart rate of 136 beats per minute, hypertension with a blood pressure of 160/93, and tachypnea with a respiratory rate of 35 breaths per minute. The patient was afebrile with an oral temperature of 36.3 °C, and with a pulse oximetry reading of 93% on room air. The physical exam showed a well-nourished child with a weight of 56.1 kg, in obvious respiratory distress with audible wheezing and rales to the bilateral lung fields. Heart sounds lack a noticeable rub, murmur, or gallop. There was no epistaxis present and no dried blood noted in the nares.

Laboratory evaluation was remarkable for leukocytosis with bandemia, a white blood cell count noted at 19.1 K/µL, and an initial lactic acidosis of 2.4 mmol/L. Venous blood gas revealed a pH of 7.34 with a pCO2 of 56.1 mmHg and an HCO3 of 29.5 mmol/L. Electrolytes and renal function were all within normal limits. The COVID-19 polymerase chain reaction (PCR) was negative on two separate tests.

Initial management included intramuscular epinephrine, albuterol-ipratropium nebulizers, followed by a non-rebreather mask with high-flow oxygen, dexamethasone, and a 1-liter fluid bolus. Her initial chest X-ray was negative for pulmonary infiltrate, vascular congestion, and pneumothorax (Figure 1). Despite initial management, her condition worsened, with increased work of breathing, and a decision was made to intubate her due to impending respiratory failure. She developed apnea and desaturated down to 80%. Bag-valve-mask (BVM) ventilation was successful at correcting the hypoxia. She was induced with etomidate and rocuronium and was intubated utilizing video-laryngoscopy. The endotracheal tube (ETT) is visualized appropriately passing through the glottic opening. When ventilation was attempted using a bag valve mask, the respiratory therapist noted that the BVM could not easily be compressed and the child could not be ventilated. Due to concern that the ETT had become occluded or dislodged, the balloon was deflated and the patient was extubated. No occlusion was noted in the ETT at this time. Oxygen saturation at this time remained in the mid-90s and intubation was again performed utilizing video-laryngoscopy with BVM ventilation in-between attempts. On the second intubation attempt, the posterior oropharynx was without signs of trauma, bleeding, or occlusion. The ETT was again visualized passing through the glottic opening, the stylet was removed, and the cuff was inflated prior to the video-laryngoscopy blade being removed, ensuring ETT positioning. When ventilation was attempted, it was again noted that the BVM was exceptionally difficult to compress, and the child again could not be ventilated. Anesthesia was called emergently to the bedside. At this time, the patient was noted to become hypoxic with oximetry readings in the mid-70s. BVM ventilation was performed, now with only a slight improvement in oxygen saturations to the mid-80s. A third attempt at intubation was performed as before, again with failure to ventilate. At this time, the patient experienced worsening hypoxia and became bradycardic into his low 40s. Chest compressions were started, and the ETT was again removed in a similar fashion as before. During cardiopulmonary resuscitation, ventilation with BVM was noted to cause moderate gastric distention and no appreciable chest rise. The abdomen was manually decompressed without significant change in hemodynamics. The anesthesia team arrived at the bedside and successfully intubated the patient using video-laryngoscopy and a 7.0 ETT. It was at this time that ventilation was successful, with rapid improvement in oxygen saturation and heart rate. The total time of chest compressions was less than one minute with no pharmacology needed. Following intubation, bloody secretions were noted in the ETT, which were easily suctioned. Numerous blood clots and mucous plugs were also suctioned from the patient’s airway. Given concern for false-negative COVID-19 PCR, a repeat specimen was obtained, again with negative results. It is highly suspected that chest compressions and more forceful ventilation dislodged mucus plugs/blood clots in the airway, allowing for proper ventilation. An orogastric tube was placed for gastric decompression with the evacuation of non-bloody stomach contents. A repeat chest X-ray following intubation demonstrated adequate ETT positioning and bilateral diffuse patchy infiltrates with a formal read stating, "suspected to be due to fluid overload" (Figure 2). The patient was transferred to a tertiary children’s hospital for continued management via a pediatric critical care ambulance. She was admitted to the pediatric intensive care unit.

Cardiology was consulted due to evidence of pulmonary vascular congestion seen on chest X-ray and acquired an echocardiogram, which demonstrated normal ventricular function and cardiac anatomy, and ultimately signed off.

Infectious disease obtained blood cultures, respiratory syncytial virus/COVID-19/influenza PCR were all negative. The COVID-19 antigen was noted to be positive. A urinalysis was obtained due to the unknown source of the suspected infection. This was notable for microscopic hematuria and proteinuria with 3+ blood and 2+ protein. Urine, blood, and respiratory cultures had no growth after four days of incubation. She was treated with an abbreviated course of clindamycin, ceftriaxone, and vancomycin, discontinued due to negative cultures, and a full course of azithromycin for possible pneumonia.

Due to the patient requiring mechanical ventilatory support, repeat chest X-rays were obtained. Each of these new chest X-rays demonstrated continued evidence of bilateral infiltrates with areas of concerning worsening and increased infiltrate burden. It was at this time that the concern for pulmonary hemorrhages causing the infiltrates was seen. A renal ultrasound was obtained which demonstrated normal renal anatomy without evidence of hydronephrosis. During this ultrasound examination, there was evidence of a blood clot in the inferior vena cava.

A nephrologist was consulted due to the finding of microscopic hematuria, and a left renal biopsy was obtained due to concern about underlying vasculitis. Blood samples were remarkable at this time for elevated anti-proteinase 3 and c-antineutrophil cytoplasmic antibodies (ANCA) along with negative anti-double-stranded DNA, low anti-nuclear antibodies, and low C4 levels. Clinical symptoms along with biopsy and lab results were consistent with a diagnosis of c-ANCA-related vasculitis and glomerulonephritis with polyangiitis. The rheumatology service was consulted for the management of GPA and the patient was started on intravenous methylprednisolone and cyclophosphamide. Venous duplex ultrasounds were obtained of the upper and lower extremities, which demonstrated evidence of deep-vein-thrombosis in the right radial vein and cephalic vein at the antecubital fossa, for which the patient was started on enoxaparin.

The rheumatologist started the patient on a steroid burst with 1 gram of methylprednisolone followed by a slow, prolonged taper thereafter. The patient was also started on oral cyclophosphamide. The patient remained intubated for a period of 12 days and was then successfully extubated. She was able to complete prolonged continuous positive airway pressure (CPAP) trials starting on day 9.

She experienced a vast improvement in her clinical presentation, and following a prolonged hospital course, she was ultimately discharged home with cyclophosphamide, prednisone, and enoxaparin with continued outpatient rheumatology follow-up.

Granulomatosis with polyangiitis, previously known as Wegener’s disease (WD), is a vasculitis subtype affecting predominantly small vasculature. The disease is characterized by its association with ANCAs [3]. There is an incidence estimated at 3 per 100,000 individuals with a slight female predominance and is most often diagnosed in the 4th through 6th decades of life, with childhood diagnosis being significantly less common [4]. Initial presentation can take many forms and include constitutional, cutaneous, pulmonary, ear, nose and throat, and renal symptoms, with the most common presenting symptoms including constitutional manifestations [5]. Children typically present with more severe manifestations involving renal, gastrointestinal, and pulmonary organ involvement [6]. These can include airway obstruction and pulmonary hemorrhage, as seen in our patient.

The classic presentation includes pulmonary and renal involvement due to the abundance of capillaries surrounding the alveoli and glomeruli, respectively [7]. It is not uncommon for these patients, particularly children, to present with significant respiratory distress due to an obstructed airway from bleeding and clot formation within the airway itself [8]. Pulmonary hemorrhage can be suspected clinically and through basic radiology imaging and confirmed through direct visualization with bronchoscopy or advanced imaging such as CT or MRI. Hematuria is not always overt and may be missed unless clinical suspicion is high. Incidental findings of microscopic hematuria are common and may aid in the diagnosis and prompt further workup, such as in this patient who underwent a kidney biopsy.

The most striking moment in the emergency management of this patient revolved around the inability to ventilate after successful endotracheal intubation. When encountered with difficulties ventilating any patient, one should consider these four scenarios: dislodgement, obstruction, pneumothorax, or equipment failure.

In the case of this patient, there was low suspicion of a dislodged tube, as we had direct visualization of the endotracheal tube passing through the glottic opening. There was no evidence of pneumothorax on the initial chest X-ray and, given the lack of trauma, we had overall low suspicion. The patient was not attached to a ventilator, and the bag valve mask was fully functional, leading to a low suspicion of equipment failure. This left the high likelihood of an obstruction within the larger airway structures such as the trachea, bronchi, or potentially the endotracheal tube itself. Following the subsequent bradycardic cardiac arrest, with successful intubation, it was noted that multiple significantly sized blood clots were able to be suctioned from the patient's airway. This raised suspicion of pulmonary hemorrhage and obstructive blood clots as a cause of her respiratory distress and subsequent cardiopulmonary arrest.

In a child with otherwise normal anatomy who is noted to have a failure to ventilate, a subglottic obstruction of the larger airway structures should be considered. Remedying this situation may take many forms, including the use of in-line suction, advancing the endotracheal tube to attempt to dislodge the obstruction into a mainstem bronchus, or, in the case of cardiac arrest or the patient becoming unresponsive, chest compressions may provide dislodgement [9]. If the obstruction can not be dislodged or removed, a surgical cricothyroidotomy may be performed, but only if the obstruction is determined to be above the level of the cricothyroid membrane. In addition to subglottic obstructions, if there is a visualized supraglottic obstruction, removal with Magill forceps or Yankauer suction is indicated [9].

While granulomatosis with polyangiitis is an uncommon diagnosis for an emergency department provider, it should be considered when caring for an otherwise healthy child who presents with shortness of breath, epistaxis, and constitutional symptoms. As with every intubation, a failure to ventilate should result in a step-wise approach to troubleshooting the underlying cause.

Shortness of breath continues to be a common complaint prompting evaluation in the emergency department and a leading chief complaint in the pediatric community. While the majority of patients will be diagnosed with a subtype of reactive airway disease and/or respiratory tract infection, the potential for an autoimmune cause should be considered, especially in those patients who do not respond to conventional treatment. In the case of this patient, there was no initial radiographic evidence of pulmonary infiltrate, and laboratory findings were not remarkable for infectious etiologies. The poor overall appearance and physical examination of the child did not match the severity of the laboratory and imaging results. Following intubation, any failure to ventilate should follow a stepwise, organized approach to diagnosing the underlying issue.



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Most Recent Updates:

Click the dates to jump to more details.

  • June 14: Researchers compared the adverse effects experienced by patients who took Pfizer or Moderna’s mRNA vaccine over the course of 42 weeks. The risk was very low for both, but those that took Pfizer’s were slightly more likely to suffer heart attacks or strokes. The researchers say there is a possibility that these outcomes are not linked to the vaccines, but to Covid infections, and that the results could also belie a slightly lower efficacy of Pfizer’s vaccine. They emphasize the benefits of both vaccines still outweigh the risks.
  • May 6: The FDA has limited the use of the J&J vaccine after 60 cases of blood clots associated with thrombocytopenia syndrome have been discovered. 18.7 million doses of the shot have been administered, and regulators don’t yet know who is at the highest risk of clots.
  • January 25: COVID vaccination did not impact the likelihood of couples conceiving in a recent study.
  • January 21: The NIH is investigating the possibility that the vaccines cause long covid-like symptoms such as irregular heart rates and brain fog in very rare cases.
  • January 7: Moderna and Pfizer shots are associated with a temporary increase in menstrual cycle length of just under a day, according to a new study. The researchers say future studies will look at breakthrough bleeding and heavy flows, which have been reported anecdotally.
  • January 3: The FDA has authorized third shots of the Pfizer vaccine for teens 12-15 years old, and immunocompromised children between 5-11 years old. The agency also shortened the amount of time between the second and third shots from six months to five months.
  • December 31: CDC data shows that serious side effects of Pfizer’s shot are extremely rare in children 5-11. While many reported arm pain, fevers and muscle pain like the adults, only 11 out of more than 40,000 reported myocarditis. Seven of those have fully recovered and four are currently improving.
  • December 16: The CDC’s vaccine advisors are meeting to review data that suggests a heightened risk of clotting disorders in patients who received the J&J vaccine. Women aged 30-49 appear to be the most affected, though the condition likely impacts 1 out of 100,000 vaccine recipients. Nine have died.
  • December 8: The FDA authorized Astrazeneca’s monoclonal antibody treatment as an alternative to the vaccine for people over 12 years old who are immunocompromised or have a history of severe vaccine reactions. The treatment is given in two injections and protection is thought to last 6 months up to a year. It reduced the risk of symptomatic COVID-19 by 82%.
  • October 27: MedShadow reached out to cardiologist Jennifer Su, MD, to help you understand the risk of myocarditis in kids and teens who receive the COVID-19 vaccines. Read the article here.

To help you sort through the news on the COVID-19 vaccine’s progress, MedShadow has created the MedShadow Vaccine Tracker, the only tracker focused on the side effects and adverse events associated with proposed COVID-19 vaccinations.

Rather than injecting patients with a weakened virus or proteins from the pathogen that our immune systems can recognize, which is what’s typically done when we get a flu vaccine, the new vaccines from Moderna and Pfizer — the two that made it to the market first in the U.S. — contain mRNA (messenger RNA), which is a genetic template that instructs our cells to build the viral proteins that our immune systems can then recognize. Its main perk is that allowing our bodies to produce the proteins (rather than growing them in a lab like traditional vaccines) slashes production time. For nearly 20 years, researchers have been interested in using mRNA in vaccines; and some were even tested in early clinical trials for rabies, influenza and Zika. However, the vaccines for COVID-19 will be the first mRNA vaccines ever authorized by the FDA.

Some risks and minor side effects, such as a sore arm where the vaccine is injected or a light skin rash, are clearly worth the benefit of being protected against a disease. Where to draw the line at what is or is not acceptable is a personal decision. That’s where the MedShadow Vaccine Tracker can help. 

On the tracker, we will be publishing up-to-date Phase 3 results information about the risks of each vaccination. Phase 3 tests the vaccine for safety and efficacy in large groups of people (tens of thousands) and is the last stage before the FDA considers approval for use in the population at large. We continue following verified reports as the vaccines are offered to the general public. It is important to note that reports of events occurring after vaccination are not inherently linked to it. As countries begin to vaccinate hundreds of millions of people, some would inevitably be diagnosed with illnesses or pass away each day with or without the injections.

Jump to:

ModernaPfizerCanSinBio (China) | Gameleya (Russia) | Johnson & Johnson

AstrazenecaNovavax (UK)Sinopharm (China)Sinovac (China)Murdoch (England)|Bharat Biotech

 


Moderna

Moderna started Phase III clinical trials for its vaccine candidate in July. In earlier trials, nearly half of patients experienced common adverse effects like injection site pain, rash, headaches, muscle soreness, nausea and fevers after the second injection. These effects generally subsided within two days. CNBC spoke to a few individuals, some participating in Moderna’s trial and some in Pfizer’s trial who said much the same thing: the side effects were intense and included a high fever, body aches, bad headaches and exhaustion, but were worth it for protection from Covid-19.

In the FDA report published in December, the most common side effects were pain at injection site (91.6% of patients), fatigue (68.5%), headache (63.0%), muscle pain (59.6%), joint pain (44.8%), and chills (43.4%). Three patients experienced Bell’s Palsy, a sudden, and usually temporary, weakening or paralysis of the facial muscles.

The CDC reports that 11% of patients experienced swollen lymph nodes after the first shot. That raised to 16% after the second shot.

A few patients with facial fillers experienced swelling after receiving the vaccine. They were treated with antihistamines and steroids.

January 18: In California, officials halted the use of one particular batch of Moderna vaccines (lot 41L20A) after a small cluster (fewer than 10) of patients at one particular site experienced allergic reactions that required medical attention.

February 1: A study posted on Feb 1 showed that patients who received the vaccine after having been previously infected with COVID-19 showed greater immune response to the first shot and more intense side effects that are associated with strong immune responses like fever and muscle aches. The study included patients who received either the Moderna or Pfizer vaccine. Some scientists believe these patients may only need a single shot to provide sufficient immunity, but more research is needed.

February 12: Out of the first 7.5 million doses administered from Dec 14- Jan 18, 19 cases of anaphylaxis were reported to VAERS after the Moderna vaccine. No patients have died from anaphylaxis. Patients are now being monitored for 15-30 minutes after receiving the vaccine to watch for signs of anaphylaxis. The CDC suggests that anyone who has an immediate allergic reaction to a single dose of an mRNA vaccine (Moderna or Pfizer) should not get the second dose. If your reaction was not immediate, you may be referred to an allergy specialist. The vaccines do not contain polysorbate, but do have a related ingredient, polyethylene glycol (PEG). If you have an allergy to either of these chemicals, you should not get the vaccines. 

Many patients are reporting injection site reactions that show up shortly after the injection or up to a week later. These reactions — which are characterized by swelling, redness, itching, rashes, heat and pain — are expected to last a day to a week. Physicians emphasize that while these effects can be scary, they are not dangerous and should not prevent someone from getting the second shot. So far, doctors do not report seeing these reactions after the second shot, however so few have been given so far that scientists are not sure how common it will be on round two.

March 3: Allergy researchers at Mass General Hospital created a registry for healthcare professionals to report  immediate and delayed reactions to COVID-19 vaccinations. On March 3, the researchers published a letter in the New England Journal of Medicine describing a series of 12 delayed injection site reactions including swelling and rashes. The researchers wrote that one patient received antibiotics although they were not necessary. Several others were treated with steroids or anti inflammatories. The letter included some photos and said that the reactions cleared up within a median of six days. Patients were encouraged to receive their second dose. Half of them did not experience the reaction the second time. A quarter did, but to a lesser degree.

March 8: Researchers from Mass General Brigham published a Research Letter in JAMA analyzing allergic reactions in employees who received their shots there. Out of 52,805 participants, 2.1% experienced some kind of allergic reaction, including hives, itching, rash, swelling or respiratory symptoms within the first three days after vaccination. Allergies were slightly more common with the Moderna vaccine than the Pfizer vaccine (2.2% compared to 1.95%). Sixteen experienced anaphylaxis.

Moderna has announced that it will begin testing its vaccine in children and adolescents, who they believe may have stronger immune responses, leading to more intense side effects.

April 20: Researchers have received over 25,000 responses to an online survey regarding menstrual changes after receiving any COVID-19 vaccine. The
survey is ongoing as researchers hope to gain a better understanding of future directions of research. An op-ed in the New York Times explains how the vaccines could potentially interact with menstrual cycles, and why we really don’t know yet.

April 22: The CDC published an analysis of data from the first few months of voluntary
V-safe surveys that suggested that the Moderna and Pfizer vaccines are safe for pregnant women. Pregnant patients self-reported slightly fewer side effects like fever, headache and chills than the general population, but more said they experienced nausea and injection site pain. Rates of adverse pregnancy outcomes such as pre-term birth were similar to rates seen before the pandemic. While promising, officials noted that more studies will be required.

April 26: MedShadow asked doctors about some of the unusual symptoms we’re hearing about in the comments: heart palpitations and visual disturbances. They hadn’t had patients who reported long-term symptoms, but said that if the symptoms occurred very quickly after vaccination, they could be related to allergic reactions or presyncope.

April 27: Clinical trials of Moderna and Pfizer vaccines showed 7 cases of Bell’s Palsy. An analysis published today in JAMA suggested the experience was no more frequent after these vaccines than other vaccines. It is unclear whether vaccines raise the risk of facial paralysis at all, but the authors write, “if an association between facial paralysis and mRNA COVID-19 vaccines exists, the risk is likely very low, as with other viral vaccines.”

May 5: Researchers published a detailed analysis of skin reactions after Moderna and Pfizer vaccinations, including swelling and rashes. Most patients with first dose reactions did not have reactions after their second dose. Larger reactions on the arm spreading outward from the injection site were the most common reactions among those who received the Moderna vaccine, followed by smaller localized reactions and hives. Five patients (1.9%) experienced a zoster (shingles) flare after the first dose but none after the second dose. About 1% of patients experienced a flare of an existing skin condition after each dose.

May 20: An analysis published in JAMA suggests that hearing loss is NOT a side effect of the Pfizer or Moderna vaccines.

June 10: The CDC says that as of May 31, VAERS had received 475 reports of myocarditis or pericarditis among people 30 years of age and younger who received a COVID-19 vaccine. Upon follow-up, the CDC and FDA confirmed 226 of the reports. They emphasize that more than 18 million people between ages 12-24 have received at least one dose of COVID-19 vaccine in the United States. A CDC Fact Sheet on the effect is available here.

June 23: About 1.9% of healthcare employees who received an mRNA vaccination had a skin reaction such as itching or a rash after the first dose. Most (83%) who reported a skin reaction after the first dose, did not experience it again after the second dose, according to a study today in JAMA Dermatology. Another 2.3% experienced a skin reaction after only the second dose.

August 18: The FDA and CDC authorized third shots for patients with specific conditions that compromise their immune systems. The Biden administration has also pushed for booster shots to be made available to everyone, eight months after their second dose, in response to
waning antibody levels and a rise in breakthrough infections. People who took Pfizer, Moderna or J&J’s vaccines are still highly protected against hospitalization and death. This plan is not yet authorized. The agencies are also waiting for data to provide guidelines specific to J&J vaccine recipients in the coming weeks. Around a million people have gotten third shots so far in the US and abroad. The FDA hasn’t reviewed all of the data yet, but no new safety concerns have emerged thus far. See answers to frequently asked questions regarding the booster shots here.

August 19: The FDA and CDC are investigating the possibility that Moderna’s vaccine could be up to 2.5 times more likely to be associated with myocarditis (heart inflammation), especially for males under 30 years old. If true, the effect would still be exceedingly rare and scientists say the benefits still greatly outweigh the harms of vaccination. Most patients recover on their own with minimal intervention.

October 23:Researchers found that allergies to the mRNA vaccines are not likely due to the chemical PEG. Most patients (86.7%) who experienced an immediately allergic reaction after the first shot could safely receive the second dose if pretreated with antihistamines. None of the patients required hospital admission.

October 27: MedShadow reached out to cardiologist Jennifer Su, MD, to help you understand the risk of myocarditis in kids and teens who receive the COVID-19 vaccines. Read the article here.

Dec 8: The FDA authorized Astrazeneca’s monoclonal antibody treatment as an alternative to the vaccine for people over 12 years old who are immunocompromised or have a history of severe vaccine reactions. The treatment is given in two injections and protection is thought to last 6 months up to a year. It reduced the risk of symptomatic COVID-19 by 82%.

June 14: Researchers compared the adverse effects experienced by patients who took Pfizer or Moderna’s mRNA vaccine over the course of 42 weeks. The risk was very low for both, but those that took Pfizer’s were slightly more likely to suffer heart attacks or strokes. The researchers say there is a possibility that these outcomes are not linked to the vaccines, but to Covid infections, and that the results could also belie a slightly lower efficacy of Pfizer’s vaccine. They emphasize the benefits of both vaccines still outweigh the risks.


Pfizer

Pfizer began Phase III clinical trial for its vaccine candidate in July. In earlier trials, some patients experienced common adverse effects like injection site pain, rash, headaches, muscle soreness, nausea and fevers. These effects generally subsided within two days. CNBC spoke to a few individuals, some participating in Pfizer’s trial and others in Moderna’s trial who said much the same thing: the side effects were intense and included a high fever body aches, bad headaches and exhaustion in addition to the more common side effects, but were worth it for protection from Covid-19.

Some patients described the side effects as being similar to a bad hangover. A nurse who participated in the clinical trial reported feeling minimal effects after the first dose, but a fever that reached more than 104 degrees Fahrenheit after the second injection, along with chills, headache, and intense injection site pain. According to researchers, her experience of having all symptoms together was rare, though many patients had one or two of these side effects. “Clinicians will need to be prepared to discuss with patients why they should trust the vaccine and that its adverse effects could look a lot like COVID-19,” the nurse wrote on Dec 7.

The FDA report published in December said the most common reactions were injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), fever (14.2%). Swollen lymph nodes occurred in 0.3% of patients. The FDA reported that four patients who received the vaccine experienced Bell’s Palsy.

January 12: A doctor in Florida died 16 days after receiving the vaccine from a rare blood disorder, acute immune thrombocytopenia. Both Pfizer and the CDC are investigating, though the company has released a statement that so far, they haven’t seen any signs in the clinical trials or data collected from early vaccinations that the death could be related to the vaccine. The blood disorder immune thrombocytopenia, has also been seen as a rare complication of COVID-19 itself, in both symptomatic and asymptomatic patients.

January 19: Twenty-three elderly patients in Norway died after receiving Pfizer’s vaccine. Officials are investigating whether or not the deaths are vaccine-related. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, suggests that while the deaths may be coincidental given the fragile population, it’s possible that side effects of the vaccines, like fevers, may have strained the frail patients’ bodies and contributed to their deaths. Norway has vaccinated about 45,000 people so far, most of whom live in nursing homes.

February 1: A study posted on Feb 1 showed that patients who received the vaccine after having been previously infected with COVID-19 showed greater immune response to the first shot and more intense side effects that are associated with strong immune responses like fever and muscle aches. The study included patients who received either the Moderna or Pfizer vaccine. Some scientists believe these patients may only need a single shot to provide sufficient immunity, but more research is needed.

February 12: Out of the first 9.9 million doses administered from Dec 14- Jan 18, 47 cases of anaphylaxis were reported to VAERS after the Pfizer vaccine. Patients are now being monitored for 15-30 minutes after receiving the vaccine to watch for signs of anaphylaxis. The CDC suggests that anyone who has an immediate allergic reaction to a single dose of an mRNA vaccine (Moderna or Pfizer) should not get the second dose. If your reaction was not immediate, you may be referred to an allergy specialist. The vaccines do not contain polysorbate, but do have a related ingredient, polyethylene glycol (PEG). If you have an allergy to either of these chemicals, you should not get the vaccines. 

March 8: Researchers from Mass General Brigham published a Research Letter in JAMA analyzing allergic reactions in employees who received their shots there. Out of 52,805 participants, 2.1% experienced some kind of allergic reaction, including hives, itching, rash, swelling or respiratory symptoms within the first three days after vaccination. Allergies were slightly more common with the Moderna vaccine than the Pfizer vaccine (2.2% compared to 1.95%). Sixteen experienced anaphylaxis.

March 30: Researchers publish a case study of a single patient in which they suspect the Pfizer vaccine may have caused a rheumatoid arthritis flare. The flare was treated, and the patient is in remission. The researchers and RA advocacy groups still advise patients to get the vaccine as the
benefits outweigh the risks of a flare up.

April 20: Researchers have received over 25,000 responses to an online survey regarding menstrual changes after receiving any COVID-19 vaccine. The survey is ongoing as researchers hope to gain a better understanding of future directions of research. An op-ed in the New York Times explains how the vaccines could potentially interact with menstrual cycles, and why we really don’t know yet.

April 22: The CDC published an analysis of data from the first few months of voluntary V-safe surveys that suggested that the Moderna and Pfizer vaccines are safe for pregnant women. Pregnant patients self-reported slightly fewer side effects like fever, headache and chills than the general population, but more said they experienced nausea and injection site pain. Rates of adverse pregnancy outcomes such as pre-term birth were similar to rates seen before the pandemic. While promising, officials noted that more studies will be required.

April 26: MedShadow asked doctors about some of the unusual symptoms we’re hearing about in the comments: heart palpitations and visual disturbances. They hadn’t had patients who reported long-term symptoms, but said that if the symptoms occurred very quickly after vaccination, they could be related to allergic reactions or presyncope.

April 27: Clinical trials of Moderna and Pfizer vaccines showed 7 cases of Bell’s Palsy. An analysis published today in JAMA suggested the experience was no more frequent after these vaccines than other vaccines. It is unclear whether vaccines raise the risk of facial paralysis at all, but the authors write, “if an association between facial paralysis and mRNA COVID-19 vaccines exists, the risk is likely very low, as with other viral vaccines.”

May 5: Researchers published a detailed analysis of skin reactions after Moderna and Pfizer vaccinations, including swelling and rashes. Nearly a quarter of patients had smaller local reactions after each of the two shots. Hives were the most common skin reaction (26% after the first shot, 18% after the second,) among patients who received the Pfizer vaccine. Several also experienced flares of existing skin conditions.

May 10: Pfizer’s vaccine received Emergency Use Authorization for 12 to 15-year-olds. The company reported that common adverse effects like chills and fever were more common in this age group than adults. Adverse reactions in adolescents 12 through 15 years of age included pain at the injection site (90.5%), fatigue (77.5%), headache (75.5%), chills (49.2%), muscle pain (42.2%), fever (24.3%), joint pain (20.2%), injection site swelling (9.2%), injection site redness (8.6%), lymphadenopathy (0.8%), and nausea (0.4%). These effects generally subsided within 1-2 days. While data on
syncope (fainting) was not included, the announcement mentioned that fainting after vaccination is more common in teens than adults, and that safety measures should be in place to reduce this risk.

May 20: An analysis published in JAMA suggests that hearing loss is NOT a side effect of the Pfizer or Moderna vaccines.

May 23: The CDC is investigating reports of myocarditis in a small number of vaccinated teens. Myocarditis, or inflammation of the heart, has multiple causes but a viral infection is the most common trigger. In 2019,
one million people were diagnosed with myocarditis, most of them under 40 years old. It’s not yet clear if these events were related to the vaccine.

June 9: A study in Nature Medicine suggests that there may be a very slightly elevated risk of blood disorders after receipt of the AstraZeneca vaccine, but NOT Pfizer’s. The study was based on an analysis of medical records in Scotland. Researchers say the vaccine’s benefits still outweigh the risks and that their results should not alter policy. The rates are similar to those seen with other common vaccines.

June 10: The CDC says that as of May 31, VAERS had received 475 reports of myocarditis or pericarditis among people 30 years of age and younger who received a COVID-19 vaccine. Upon follow-up, the CDC and FDA confirmed 226 of the reports. They emphasize that more than 18 million people between ages 12-24 have received at least one dose of COVID-19 vaccine in the United States. A CDC Fact Sheet on the effect is available here.

June 23: About 1.9% of healthcare employees who received an mRNA vaccination had a skin reaction such as itching or a rash after the first dose. Most (83%) who reported a skin reaction after the first dose, did not experience it again after the second dose, according to a study today in JAMA Dermatology. Another 2.3% experienced a skin reaction after only the second dose.

August 18: The FDA and CDC authorized third shots for patients with specific conditions that compromise their immune systems. The Biden administration has also pushed for booster shots to be made available to everyone, eight months after their second dose, in response to waning antibody levels and a rise in breakthrough infections. People who took Pfizer, Moderna or J&J’s vaccines are still highly protected against hospitalization and death. This plan is not yet authorized. The agencies are also waiting for data to provide guidelines specific to J&J vaccine recipients in the coming weeks. Around a million people have gotten third shots so far in the US and abroad. The FDA hasn’t reviewed all of the data yet, but no new safety concerns have emerged thus far. See answers to frequently asked questions regarding the booster shots here.

August 22: Researchers published two case studies of patients experiencing neurological effects such as losing balance and non-epileptic convulsions after the Pfizer and AstraZeneca vaccines. They emphasize that functional neurological disorders are
treatable.

September 2: Researchers in Israel reviewed medical records of patients who had experienced Guillan-Barre Syndrome (GBS) prior to receiving Pfizer’s COVID-19 shot. Of the 579 patients, five were transferred to the hospital for neurological symptoms such as tremors or prickling sensations. Only one patient required medical care for relapse of GBS.

September 28: V-Safe data from 306 people who received their third shots showed that nearly identical numbers of patients reported side effects to the second and third shots. 79.4% and 74.1% reported local or systemic reactions, respectively, after the third dose compared to 77.6% and 76.5% who reported local or systemic reactions after the second dose, respectively.

October 23: Researchers found that allergies to the mRNA vaccines are not likely due to the chemical PEG. Most patients (86.7%) who experienced an immediately allergic reaction after the first shot could safely receive the second dose if pretreated with antihistamines. None of the patients required hospital admission.

October 27: MedShadow reached out to cardiologist Jennifer Su, MD, to help you understand the risk of myocarditis in kids and teens who receive the COVID-19 vaccines. Read the article here.

Dec 8: The FDA authorized Astrazeneca’s monoclonal antibody treatment as an alternative to the vaccine for people over 12 years old who are immunocompromised or have a history of severe vaccine reactions. The treatment is given in two injections and protection is thought to last 6 months up to a year. It reduced the risk of symptomatic COVID-19 by 82%.

Dec 31: CDC data shows that serious side effects of Pfizer’s shot are extremely rare in children 5-11. While many reported arm pain, fevers and muscle pain like the adults, only 11 out of more than 40,000 reported myocarditis. Seven of those have fully recovered and four are currently improving.

June 14: Researchers compared the adverse effects experienced by patients who took Pfizer or Moderna’s mRNA vaccine over the course of 42 weeks. The risk was very low for both, but those that took Pfizer’s were slightly more likely to suffer heart attacks or strokes. The researchers say there is a possibility that these outcomes are not linked to the vaccines, but to Covid infections, and that the results could also belie a slightly lower efficacy of Pfizer’s vaccine. They emphasize the benefits of both vaccines still outweigh the risks.


CanSinBio (China) 

China granted the CanSinBio vaccine emergency approval prior to beginning a Phase III trial in August. In the Phase II trial, nearly three-quarters of patients reported at least one common mild adverse events including injection site pain, rash, headaches, muscle soreness, and fevers. Five people also reported vomiting.


Gamaleya Research Institute (Russia)

Gamaleya Research Institute launched Phase III trials in August. But before they got started, President Putin announced that the vaccine was approved early, however, the Phase III trials are expected to continue. In the earlier trials, almost all of the patients experienced low-grade fevers. A small number of patients reported heart palpitations. Otherwise, reported side effects were similar to other vaccines and included injection site pain, rash, headaches, and muscle soreness.

Feb 2: The group reported efficacy data along with some data on side effects in The Lancet. The most common adverse events were flu-like illness (15.2% of those vaccinated) and local reactions (5.4% of those vaccinated).

The report also states that there were six grade 3 adverse events which were not associated with the vaccination: acute sinusitis, an exacerbation of urolithiasis along with renal colic and deep vein thrombosis (both associated with pre-existing comorbidities) and extremity abscess (due to physical injury and subsequent infection of the wound surface of the soft tissues of the finger).


Johnson & Johnson

Johnson & Johnson started a Phase III trial for its vaccine candidate in September 2020, but paused it on October 12 due to an unexplained illness and remains on hold. The company announced it would restart the trial on October 26. Pauses are common during clinical trials to evaluate specific adverse events, but the company has not shared details about the illness experienced by one of the trial volunteers. In earlier trials, about 70% of patients experienced at least one mild adverse effect similar to those seen with other vaccines, including injection site pain, rash, headaches, muscle soreness, and fevers.

On Feb 24, Johnson & Johnson shared data from its Phase III trials. The data suggested that while the vaccine is slightly less protective overall (but more protective against the 501Y.V2 variant that emerged from South Africa,) than the Moderna and Pfizer vaccines, it produced fewer side effects.

The report says the most common reactions were injection site reactions (50.2%), fatigue (38.2%), headache (38.9%), muscle pain (33.2%), nausea (14.2%) and fever (9.0%).  Reactions were more common in patients under 60 than over 60.

Injection site pain lasted a median of 2 days, but up to 7 days in 2.3% of patients.

April 8: A vaccination site in Colorado paused operations after 11 patients became nauseous and dizzy minutes after receiving the Johnson & Johnson vaccine. Two patients were transmitted to the hospital, but the rest were deemed healthy enough to return home. Officials said that those vaccinated at the same site should not be concerned.


April 13: The U.S. is calling for a pause on distributing the Johnson & Johnson vaccine while the FDA and CDC investigate blood clots that occurred in six patients (out of 7 million who received the vaccine so far.) One patient died and another was hospitalized. All the clots occurred in women under 50 within two weeks of receiving the vaccine. The issue is similar to the one seen with the AstraZeneca vaccine in Europe.

April 20: Researchers have received over 25,000 responses to an online survey regarding menstrual changes after receiving any COVID-19 vaccine. The survey is ongoing as researchers hope to gain a better understanding of future directions of research.

April 23: The U.S. is resuming use of the vaccine after finding only 15 total cases of blood clots out of the 7 million vaccinated. Patients will be warned about the risk at vaccination sites. Symptoms including headache, leg pain and abdominal pain occur 6-14 days after vaccination. If you have these symptoms you should seek emergency medical treatment. It is treatable with certain blood thinners.

April 26: MedShadow asked doctors about some of the unusual symptoms we’re hearing about in the comments: heart palpitations and visual disturbances. They hadn’t had patients who reported long-term symptoms, but said that if the symptoms occurred very quickly after vaccination, they could be related to allergic reactions or presyncope.

April 27: Doctors suggested that patients with a history of immune-mediated thrombocytopenia, such as heparin-induced thrombocytopenia, should not get the Johnson and Johnson vaccine (mRNA vaccines like Pfizer and Moderna are ok). If you’re at an increased risk for other types of blood clots, (because you have obesity or you smoke, for example) you do not have an elevated risk of blood clots with the J&J vaccine.

April 30: Researchers published detailed data about 12 patients who experienced blood clots in JAMA.

May 13: The CDC has identified more cases of the rare clotting disorder associated with the J&J vaccine. The total is 28 cases. Three patients have died and four are still hospitalized. It’s more common in women than in men, and the benefits still outweigh the risks of vaccination, officials say. Nine million doses of the vaccine have been delivered in the U.S.

May 26: A 37-year old woman in Belgium died from a blood clot thought to be related to the Johnson and Johnson vaccine she received. The country has stopped using the vaccine in patients under the age of 41.

July 12: The FDA is attaching a warning to the Johnson & Johnson vaccine about a slightly elevated risk of developing Guillain-Barre syndrome, which can cause paralysis, within three weeks of receiving the vaccine.  About 100 cases have been identified. Most patients recovered. One 57-year-old man died. The benefits still out weight the risks of vaccination, it says.

August 22: The FDA and CDC authorized third shots for patients with specific conditions that compromise their immune systems. The Biden administration has also pushed for booster shots to be made available to everyone, eight months after their second dose, in response to waning antibody levels and a rise in breakthrough infections. People who took Pfizer, Moderna or J&J’s vaccines are still highly protected against hospitalization and death. This plan is not yet authorized. The agencies are also waiting for data to provide guidelines specific to J&J vaccine recipients in the coming weeks. Around a million people have gotten third shots so far in the US and abroad. The FDA hasn’t reviewed all of the data yet, but no new safety concerns have emerged thus far. See answers to frequently asked questions regarding the booster shots here.

Dec 8: The FDA authorized Astrazeneca’s monoclonal antibody treatment as an alternative to the vaccine for people over 12 years old who are immunocompromised or have a history of severe vaccine reactions. The treatment is given in two injections and protection is thought to last 6 months up to a year. It reduced the risk of symptomatic COVID-19 by 82%.

Dec 16: The CDC’s vaccine advisors are meeting to review data that suggests a heightened risk of clotting disorders in patients who received the J&J vaccine. Women aged 30-49 appear to be the most affected, though the condition likely impacts 1 out of 100,000 vaccine recipients. Nine have died.

May 6: The FDA has limited the use of the J&J vaccine after 60 cases of blood clots associated with thrombocytopenia syndrome have been discovered. 18.7 million doses of the shot have been administered, and regulators don’t yet know who is at the highest risk of clots.


Astrazeneca

On September 6, the company paused the trial to investigate a patient who developed transverse myelitis – dangerous inflammation of the spinal cord. Researchers determined that the incident was unrelated to the vaccine and quickly restarted the trial in most countries, however it remained paused in the US until October 26. On October 21, scientists reported a patient in the trial had died, however, according to a local newspaper, the patient was in the control arm of the trial, meaning they’d received a placebo instead of the vaccine, so the trial is ongoing.

In earlier trials, many patients reported mild adverse effects similar to those associated with the other vaccines including injection site pain, rash, headaches, muscle soreness, and fevers. The team gave some of these patients preventative acetaminophen to reduce pain and fever. Nearly half of patients also experienced temporary neutropenia – a reduction in white blood cells that can make a person more susceptible to infections.

The vaccine has been approved for use in the U.K., Argentina, India, E.U. and Mexico.

March 11: Denmark has paused the use of the AstraZeneca vaccine while it investigates whether it is responsible for blood clots — one fatal — in some patients.

“It is important for us that the citizens are confident in the offer we give them and trust that we can vouch for the quality of the vaccines we have in our program. Therefore, we react promptly until we have investigated whether there is a connection between the vaccine and the possible side effects ,” officials wrote in a press release.

March 15: Several other countries (Iceland, Norway, Denmark, Ireland, the Netherlands, Italy, France and Germany) have also paused use of the vaccine while unusual clotting events are investigated. Meanwhile, Thailand, which paused its use on Friday, March 12 restarted it on Sunday, March 14. On Sunday, AstraZeneca released a statement that its own review revealed “no increased risk” of clotting issues with the vaccine and that “So far across the  EU and UK, there have been 15 events of DVT [deep vein thrombosis] and 22 events of pulmonary embolism reported among those given the vaccine, based on the number of cases the Company has received as of 8 March. This is much lower than would be expected to occur naturally in a general population of this size and is similar across other licensed COVID-19 vaccines.”

March 18: The European Medicines Agency (EMA) issued a statement that the benefits of the AstraZeneca vaccine outweigh the risks. The vaccine is not associated with an overall risk of blood clots, though there may be a very small increased risk of certain types of clots. The statement reads, “These are rare cases – around 20 million people in the UK and EEA had received the vaccine as of March 16 and EMA had reviewed only 7 cases of blood clots in multiple blood vessels (disseminated intravascular coagulation, DIC) and 18 cases of CVST [clots in the vessels that drain blood from the brain.] A causal link with the vaccine is not proven, but is possible and deserves further analysis.” These cases were more common in women under the age of 55. Germany, France, Italy, Latvia, Bulgaria and Slovenia have all stated that they’d restart or continue to offer the AstraZeneca vaccine in light of the news.

April 7: The EMA still says the benefits of the vaccines outweigh the risks. However, the group has suggested that blood clots be listed as a possible, albeit rare, side effect of the injection and that both patients and doctors be aware of the signs which include: shortness of breath, chest pain, leg swelling, persistent abdominal pain, neurological symptoms like blurry vision and blood spots under the skin beyond the site of injection. If you have these symptoms, seek medical assistance.


April 9: Out of 34 million recipients of the vaccine, 222 have reported blood clots. They appear to be more likely in younger patients, but it’s otherwise impossible to predict who will experience them. Some experts say they can be treated with intravenous immune globulin, which is currently used to treat immune disorders along with some types of blood thinners.

June 9: A study in Nature Medicine suggests that there may be a very slightly elevated risk of blood disorders after receipt of the AstraZeneca vaccine, but not Pfizer’s. The study was based on an analysis of medical records in Scotland. Researchers say the vaccine’s benefits still outweigh the risks and that their results should not alter policy. The rates are similar to those seen with other common vaccines.

August 22: Researchers published two case studies of patients experiencing neurological effects such as losing balance and non-epileptic convulsions after the Pfizer and AstraZeneca vaccines. They emphasize that functional neurological disorders are
treatable.

Dec 8: The FDA authorized Astrazeneca’s monoclonal antibody treatment as an alternative to the vaccine for people over 12 years old who are immunocompromised or have a history of severe vaccine reactions. The treatment is given in two injections and protection is thought to last 6 months up to a year. It reduced the risk of symptomatic COVID-19 by 82%.


Novavax (United Kingdom)

Novavax began Phase III clinical trials with its vaccine candidate in the United Kingdom in September and is had planned to start a trial in the United States in October. The trial was delayed due to manufacturing problems. The U.S. trial started on December 28. During Phase I/II trials, patients reported adverse events similar to those of other vaccine candidates, including injection site pain, rash, headaches, muscle pain, fever, nausea and vomiting. 

June 14: Novavax announced promising efficacy data in a press release. The release
suggested that the vaccine has similar side effects to others already approved, but that they may be slightly milder. Complete data is not yet available.


 Sinopharm (China) 

In July, Sinopharm launched Phase III trials of its two vaccine candidates in the United Arab Emirates, Peru, Morocco, and Argentina, which are now approved for limited use in healthcare workers in China and the UAE. In earlier trials of one of the vaccines, made in collaboration with Wuhan Institute of Biological Products, about 15% of the patients reported adverse events similar to those of other vaccine candidates, including injection site pain, rash, headaches, muscle pain, fever, nausea and vomiting. There is little data available about the second vaccine, made in collaboration with the Beijing Institute of Biological Products.


Sinovac (China)

Sinovac opened Phase III trials of its vaccine candidate, CoronaVac, in July. It is already being used with emergency approval for high risk individuals in China. The earlier trials showed that about a third of patients experienced adverse effects similar to those in other vaccine candidates like injection site pain, fever, and fatigue, but the study included few details about more specific symptoms like nausea, headaches, and vomiting. On November 10, the trial was halted in Brazil due to a participant’s death. However, researchers say the death was not vaccine-related and the trial should continue. It has not been halted in other countries.


Murdoch Children’s Research Institute (England)

The Murdoch Children’s Research Institute is running a Phase III trial repurposing Bacillus Calmette-Guerin — a vaccine developed nearly a century ago to prevent tuberculosis infections — to prevent Covid-19. Since the vaccine has been around such a long time, there are many reports on its potential adverse effects and the vaccine itself has been altered to minimize many of them. Injection site reactions are common, and lymphadenitis, swelling of the lymph nodes, is common.  

Bharat Biotech

Bharat Biotech announced it would begin Phase III trials in India on October 23. In early trials demonstrated side effect profiles similar to those of the other vaccines, including pain at the injection site, fatigue, headache, and fever. The country announced emergency approval, though no Phase III data was included in the announcement.

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Cystic fibrosis is a progressive inherited disorder most often associated with lung damage that limits breathing. It can also affect the pancreas and digestive tract. Most people with this disorder develop lung complications and frequent infections. Over time, this can lead to severe health consequences, like pneumonia, and even death.

This article discusses the link between cystic fibrosis and pneumonia as well as symptoms, causes, diagnosis, and treatment.

Nikodash / Getty Images


What’s the Link Between Cystic Fibrosis and Pneumonia?

Cystic fibrosis is an inherited disorder that affects many organ systems, but its damage to the lungs is the most concerning problem. People develop frequent episodes of pneumonia or bronchitis, which can lead to severe complications and early death. 

The faulty gene causing cystic fibrosis disrupts the movement of salts and water in the body, which leads to a buildup of mucus in places that can damage organ systems. The buildup of thick mucus is most prominent in the lungs, making it difficult for a person to clear bacteria that enter the lungs. Thus, people with cystic fibrosis frequently develop bacterial pneumonia.

Over time, repeated episodes of pneumonia lead to chronic (long-term) lung damage. Additionally, the overuse of antibiotics to treat frequent infections leads to antibiotic resistance. Eventually, the lung damage is so severe and the treatments no longer effective that a person cannot survive.

How Many People Have Cystic Fibrosis?

Cystic fibrosis affects approximately 30,000 people in the United States.

Symptoms of Lung Infections

Cystic fibrosis affects many different organ systems. Often, the initial symptoms of the disease are due to problems in the pancreas and intestines. People with cystic fibrosis cannot digest food because of a lack of digestive enzymes from the pancreas, which leads to malnutrition.

Since cystic fibrosis is an inherited disorder, the symptoms can start when a person is a baby. The initial symptoms of lung disease are nonspecific and include:

Newborns in the United States are screened for cystic fibrosis so the illness can be detected and symptoms treated as early as possible. However, in places without neonatal screening for cystic fibrosis, these nonspecific lung symptoms are initially misdiagnosed as asthma, mild bronchitis, or pneumonia not related to an underlying lung problem.

Which Organs Are Affected by Cystic Fibrosis?

The two central organ systems affected by cystic fibrosis are the lungs and pancreas. However, two other common problems that people with cystic fibrosis develop include recurrent episodes of sinusitis and diabetes.

Causes of Pneumonia and Other Lung Infections

Bacteria and viruses constantly circulate in the environment, and they can be passed from one person to another through respiratory droplets, such as by coughing or sneezing. Most people can clear their lungs of these invaders by producing mucus that can be coughed up and expelled.

However, people with cystic fibrosis are unable to clear mucus from their lungs. When mucus mixed with bacteria sits for a long time in a part of the lung, the area becomes inflamed and the person develops pneumonia.

Bacterial Causes

Early in life, the bacterial organisms that usually lead to pneumonia in people with cystic fibrosis are:

  • Staphylococcus aureus
  • Haemophilus influenzae

As a person’s lungs become repeatedly damaged from recurrent infections, other, more unusual and dangerous bacteria cause pneumonia, including:

  • Pseudomonas aeruginosa
  • Burkholderia cepacia 
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Stenotrophomonas maltophilia
  • Achromobacter xylosoxidans 

Once a person has been infected and has lived with Pseudomonas aeruginosa for a while, they develop severe lung infections more frequently, have a more rapid decline in lung function, and are at higher risk for death. 

Most Common Causes of Bacterial Pneumonia

Staphylococcus aureus is the most common bacterial organism found in children and adolescents with cystic fibrosis. The most common bacterium found in adults with cystic fibrosis is Pseudomonas aeruginosa.

Viral Causes

Like people without cystic fibrosis, people with cystic fibrosis can develop viral infections of the lungs, such as influenza and respiratory syncytial virus (RSV). People with cystic fibrosis are not more likely to develop a viral infection. Instead, they are sicker when a viral infection occurs compared with people who do not have cystic fibrosis. 

Fungal Causes

People with cystic fibrosis can also develop pneumonia caused by a fungus instead of a bacteria. The most common fungal organism that leads to pneumonia in patients with cystic fibrosis is Aspergillus fumigatus.

Diagnosis

In the United States, there is a nationwide program that screens newborn infants for cystic fibrosis. The screening is performed in the first few days of life from a few drops of blood. Different states use different screening tests to confirm the diagnosis.

Newborn screening tests are vital because they help parents and healthcare providers know when to begin specialized cystic fibrosis treatments. Initiating treatment early extends the time without complications. 

If an infant or a person suspected of having cystic fibrosis tests positive during the initial screening test, they are given an additional test. This definitive diagnostic test is called a sweat test. It measures the amount of electrolytes in a person's sweat.

What Are Autosomal Recessive Carriers?

Testing for cystic fibrosis involves looking for the gene responsible for the disease. Some people are carriers of the gene but do not develop the disease. This is because the gene is autosomal recessive (passing from both parents to a child). If you are one of these people, speak with your healthcare provider about what this means.

Treatment

When people are treated for pneumonia several times over several years, they eventually develop antibiotic resistance. When a particular bacteria is resistant to many different antibiotics, the organism is called a multidrug-resistant bacterium. Infections from these types of bacteria are complicated to treat and can lead to death from pneumonia in a person with cystic fibrosis.

Healthcare providers need to treat Pseudomonas aeruginosa colonization or pneumonia early to help clear the infection. People chronically infected with the specific bacteria are treated regularly with inhaled antibiotics, such as tobramycin, which helps prevent severe infection.

What to Do About Pseudomonas aeruginosa

People with cystic fibrosis do not develop Pseudomonas aeruginosa lung infections until they are older children, young adults, or adults. Research has shown that if a person is treated early for this bacterium and the organism is destroyed completely, people live longer.

Antibiotics and Antifungals

Treatment of acute lung infections requires antibiotics. The choice of antibiotic depends on the bacterial organism in the lungs and whether a person has developed resistance to antibiotics needed to kill it.

If a person develops fungal pneumonia, treatment involves an antifungal agent and corticosteroids.

Airway Clearance Techniques 

Since people with cystic fibrosis cannot clear mucus out of their lungs, other treatments include airway clearance techniques. Examples include:

These techniques help move the mucus up and out of the airway. Airway clearance techniques are recommended daily for people with cystic fibrosis.

Regular aerobic exercise is also recommended for patients with cystic fibrosis because it stabilizes lung function.

Inhaled Therapy

People with cystic fibrosis are also encouraged to use inhalers that rehydrate and break up the mucus so that it can be coughed up and expelled. The inhaled medications are called mucolytics and options include:

  • 7% hypertonic saline solution
  • Mannitol
  • Dornase alfa

Transplant

People with end-stage lung disease with cystic fibrosis are eligible for lung transplantation. People can often live an additional ten years after a lung transplant.

How to Prevent a Lung Infection

People with cystic fibrosis who are infected with Pseudomonas aeruginosa are started on chronic preventive therapy. Patients are treated with inhaled and oral antibiotics to prevent future bacterial pneumonia. The most commonly used antibiotics include:

Other general preventative measures recommended for anyone with respiratory symptoms include:

  • Handwashing
  • Using masks when in healthcare facilities or close contact with someone with a respiratory illness
  • Social distancing when needed
  • Cleaning and disinfecting nebulizers and other tools used by the cystic fibrosis patient

Summary

Cystic fibrosis is a chronic, inherited disorder that leads to frequent lung infections. Symptoms of a lung infection include cough, wheezing, and shortness of breath. People with cystic fibrosis can develop various types of pneumonia, but bacterial pneumonia is the most common.

In the United States, treatment for cystic fibrosis usually starts early because of widespread neonatal screening programs used to detect it. Treatments aim to prevent infections, treat acute infections, and rid the lungs of mucus. 

A Word From Verywell

Living with cystic fibrosis can be extremely difficult because of the number of lung infections people develop, even in childhood. However, scientists have come a long way in improving life expectancy for people with cystic fibrosis through new treatments and preventive strategies.

If you are expecting a baby, make sure you participate in cystic fibrosis screening programs for your child. If you have cystic fibrosis, follow your healthcare provider's recommendations in trying to prevent frequent lung infections. 

Frequently Asked Questions

  • What is the most common cause of pneumonia in people with cystic fibrosis?

    The most common cause of pneumonia in a child with cystic fibrosis is Staphylococcus aureus. The most common cause of pneumonia in an adult with cystic fibrosis is Pseudomonas aeruginosa.

  • What is the risk of getting pneumonia if you have cystic fibrosis?

    Due to a buildup of mucus in the lungs, patients with cystic fibrosis are at risk of developing lung infections early in life. Sometimes the first episode develops as a baby.

  • Is pneumonia a symptom of cystic fibrosis?

    A single episode of pneumonia is not a symptom of cystic fibrosis. A diagnosis of cystic fibrosis would not be suspected in a person unless they had recurrent episodes of pneumonia. Cystic fibrosis is an inherited disorder, so it usually presents early in life.

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Today host Karl Stefanovic has urged parents to be vigilant after a sudden health scare sent his young daughter to the hospital.

He opened up about the “really scary” ordeal on Friday morning while hosting Channel 9’s Today show, where he became emotional as he detailed how suddenly his one-year-old daughter Harper became seriously ill.

Two days ago, the father of four said his toddler had a “sniffle and a cough” that quickly developed into a temperature. She was laid down to sleep but woke with wheezing and difficult breaths, a racing heart rate and a soaring temperature.

The Today host said he was ‘very worried’ about his young daughter.
Camera IconThe Today host said he was ‘very worried’ about his young daughter. Credit: Supplied

Stefanovic and his wife Jasmine rushed their daughter to the GP, but the toddler’s condition worsened dramatically and she had to be rushed to hospital.

While the breakfast show host praised healthcare staff for their timely and “brilliant job”, he said he knew he was not the only parent to have gone through this “shared experience”.

“There were literally thousands of parents in similar situations,” he said.

“We are lucky it wasn’t more serious, and we were lucky we had good people around her.”

Royal Children’s Hospital paediatrician Margie Danchin agreed it was a “familiar story”.

“After the last two years being so tough with Covid for parents, we’re now seeing just a huge increase in viral respiratory infections for children,” she said.

NSW Australian Medical Association president Michael Bonning said the dramatic increase could be blamed on a lack of exposure to respiratory viruses and the flu.

“We know for infants and toddlers who may not have been exposed to (respiratory viruses and the flu) at all in the last two years, this first exposure can be quite severe,” he said.

“We know that influenza is a serious condition in children under the age of five.”

Children under the age of five are one of the most at-risk age groups for contracting the potentially “life-threatening” flu, according to a recent report.

“They‘re one of our priority groups for immunisation,” Dr Bonning said.

“That is something that we want to encourage all parents to be thinking about, especially while there‘s a bit of a blitz on for flu vaccination at the moment across the country.”

Dr Danchin said emergency departments had experienced a spike in sick children, 20 per cent of whom needed to be hospitalised.

Researching parental anxiety to tackle low vaccination rates
Camera IconDr Margie Danchin gave parents advice on how to monitor for serious symptoms. Jason Sammon Credit: News Corp Australia

Stefanvic admitted he “felt guilty” about not taking Harper straight to the hospital, but Dr Danchin said a GP was the best option for parents who may otherwise have to wait up to eight hours at the “really overwhelmed” emergency department.

She said children with mild symptoms should go to the doctor, but she urged parents to head straight to the hospital if their child had difficulty breathing, blueness around the lips, signs of dehydration and listlessness.

Parents should assess their child’s breathing by looking at the indent at the bottom of the neck and around the ribs to see whether they are breathing faster than normal or struggling to breathe.

Dr Bonning urged parents to seek professional advice early, as a child’s condition can change very quickly.

“Your GP is often a really good person to have that discussion with early at that time when it‘s a fever and a runny nose and you just want to talk to someone and get some advice,” he said.

Jasmine and Karl Stefanovic rushed their daughter Harper to hospital during the health scare.
Camera IconJasmine and Karl Stefanovic rushed their daughter Harper to hospital during the health scare. Credit: Supplied

He said knowing what to look for in terms of triggers and warning signs would help parents be prepared for the illness.

Stefanovic said he hoped sharing his family’s experience would help other families battling similar conditions.

“There’s nothing more mortifying than when one of your kids goes down and goes down quickly when they’re sick,” he said.

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