OBJECTIVES:Respiratory syncytial virus (RSV) is recognized as a leading cause of severe respiratory tract infections (RTIs) in older adults. However, the clinical burden of other paramyxoviruses-parainfluenza virus (PIV) and human metapneumovirus (hMPV)-remains under-investigated in this population. We aimed to compare morbidity and mortality associated with RSV, PIV, and hMPV infections in hospitalized adults. METHODS:Multicenter retrospective cohort study (2016-2018) in three hospitals of the Paris-Saclay network, including adults with RT-PCR confirmed RSV, PIV (1-3), or hMPV infection. Outcomes included hospital and ICU admission, short-term favorable outcome (defined as stability criteria within 5 days) and 90-day mortality. RESULTS:Of 242 patients (mean age 72.8 ± 16.2 years), 45.0% (n = 109) had RSV, 18.2% (n = 44) PIV and 36.8% (n = 89) hMPV. Overall, 88.4% were hospitalized. Median length of stay was similar across viruses (P = 0.59). In multivariable analysis, hMPV infection was independently associated with higher odds of short-term favorable outcome (adjusted OR 4.22, 95% CI [1.42-12.6]; P = 0.01), whereas eosinophil count >50/mm³ was also associated with lower ICU admission risk and better short-term outcomes. Ninety-day mortality was low and comparable (RSV 6.5%, PIV 2.4%, hMPV 5.1%; P = 0.62). CONCLUSION:RSV, PIV, and hMPV infections cause similar morbidity and mortality in hospitalized adults, yet PIV and hMPV remain markedly under-estimated causes of severe respiratory disease in this population. The unexpectedly better stability criteria observed with hMPV warrants further investigation. These findings highlight the importance of including hMPV and PIV in respiratory virus surveillance and future vaccine strategies.

Respiratory syncytial virus (RSV) peaks in fall-winter and is well known in children. In adults, however, severe outcomes especially compared to influenza are less well-defined. With RSV vaccines newly available in 2024, this study evaluated RSV burden versus influenza. Multicenter retrospective cohort study including adults ≥ 50 years with RT-PCR-confirmed influenza (A/B) or RSV during two pre-COVID-19 fall-winter seasons (2016–2018). Outcomes were hospital admission, length of stay, short-term favorable outcome (within 5 days), intensive care unit (ICU) admission, superinfection, and 90-day mortality. Of 386 patients, 288 (74.6

Objectives: Influenza significantly contributes to seasonal morbidity and strains healthcare resources, yet data directly comparing types A and B remain limited. This study assesses potential differences in clinical severity and outcomes between these two influenza types. Methods: We conducted a multicenter retrospective study of adult patients diagnosed with either influenza A or B. Using logistic regression, we identified predictors of adverse outcomes across demographics, comorbidities, and clinical parameters. Results: The influenza A and B cohorts included 234 and 113 patients, respectively. In comparison to influenza B, influenza A patients were more likely to receive oseltamivir (43.5% vs 27.9%, p = 0.01) and showed similar rates of radiological abnormalities (27.8% vs 24.8%, p = 0.6). Age ≥65 years remained the strongest predictor of hospitalization (aOR 4.78, p = 0.01). Predictors of ICU admission included age<65 (aOR 3.18, p = 0.02), radiological bilateral involvement (aOR 19.4, p < 0.001), receiving oseltamivir treatment (aOR 2.43, p = 0.01) with a trend towards documented superinfection (aOR 2.56, p = 0.07). Short-term favorable outcomes were more common in influenza B (aOR 2.52, p = 0.02), whereas chronic respiratory disease and Charlson comorbidity index reduced likelihood of favorable outcomes (aOR 0.34, p = 0.04 and 0.25, p = 0.001, respectively). Kaplan-Meier survival curves revealed similar mortality rates at 90 days between influenza A and B types (13.4% vs 8.7%, p = 0.3). Conclusion: Influenza type A and B exhibit distinct clinical trajectories and influenza B should not be neglected. These findings underscore the need for earlier diagnosis testing to promote earlier antiviral initiation and broader vaccination policies tailored to both influenza types.

Introduction: Prior to the emergence of COVID-19, when influenza was the predominant cause of viral respiratory tract infections (VRTIs), this study aimed to analyze the distinct biological abnormalities associated with influenza in outpatient settings. Methods: A multicenter retrospective study was conducted among outpatients, with the majority seeking consultation at the emergency department, who tested positive for VRTIs using RT-PCR between 2016 and 2018. Patient characteristics were compared between influenza (A and B types) and non-influenza viruses, and predictors of influenza were identified using two different models focusing on absolute eosinopenia (0/mm3) and lymphocyte count <800/mm3. Results: Among 590 VRTIs, 116 (19.7%) were identified as outpatients, including 88 cases of influenza. Multivariable logistic regression analysis revealed the following predictors of influenza: in the first model, winter season (adjusted odds ratio [aOR] 7.1, 95% confidence interval [CI] 1.12–45.08) and absolute eosinopenia (aOR 6.16, 95% CI 1.14–33.24); in the second model, winter season (aOR 9.08, 95% CI 1.49–55.40) and lymphocyte count <800/mm3 (aOR 7.37, 95% CI 1.86–29.20). Absolute eosinopenia exhibited the highest specificity and positive predictive value (92% and 92.3%, respectively). Conclusion: During the winter season, specific biological abnormalities can aid physicians in identifying influenza cases and guide the appropriate use of antiviral therapy when rapid molecular tests are not readily available.

In our in-hospital setting study, viral respiratory tract infections are at high risk of superinfection (56%), regardless of virus species, and require improving vaccination coverage among patients at risk. Background Viral respiratory tract infections (VRTIs) are among the most common diseases, but the risks of superinfection for different virus species have never been compared. Methods Multicenter retrospective study conducted among adults who tested positive for VRTIs with reverse-transcription polymerase chain reaction. We compared characteristics between influenza (A or B) and paramyxoviruses (respiratory syncytial virus, parainfluenza virus types 1 and 3, and human metapneumovirus) and identified predictors of superinfection and hospitalization.s Results Five hundred ninety patients had VRTI, including 347 (59%) influenza and 243 paramyxovirus infections with comparable rates of superinfections (53% vs 60%). In multivariate analyses, the predictors of superinfections were age >75 years (adjusted odds ratio, 2.37 [95% confidence interval, 1.65-3.40]), chronic respiratory disease (1.79 [1.20-2.67]), and biological abnormalities, including neutrophil count >7000/mu L (1.98 [1.34-2.91)], eosinophil count <50/mu L (2.53 [1.61-3.98], and procalcitonin level >0.25ng/mL (2.8 [1.65-4.73]). The predictors of hospitalization were age >75 years old (adjusted odds ratio, 3.49 [95% confidence interval, 2.17-5.63]), paramyxovirus infection (2.28 [1.39-3.75]), long-term use of inhaled corticosteroids (2.49 [1.13-5.49]), and biological abnormalities, including neutrophil count >7000/mu L (2.38 [1.37-4.12)] and procalcitonin level >0.25ng/mL (2.49 [1.23-5.02]). Kaplan-Meier survival curves showed that influenza-infected patients had a higher mortality rate than those with paramyxovirus infections (8.9% vs 4.5%, respectively; P = .02). Conclusions Our study revealed a high rate of superinfection (56%), not related to viral species. However influenza virus was associated with a poorer prognosis than paramyxoviruses, pleading for a broader and large-scale vaccination of individual at risk of VRTIs.

Background: Following a study of predictors of superinfection in viral respiratory tract infections (VRTIs), this study analyzes the predictors of the outcome. Methods: Multicenter retrospective study conducted among adults who tested positive for VRTIs with reverse-transcription polymerase chain reaction. We compared characteristics between influenza virus, Paramyxoviridae, and Pneumoviridae and identified predictors of favorable short-term outcome, admission to the intensive care unit (ICU), and mortality. Results: A total of 590 patients had VRTI, including 347 (59%) influenza infections. Mean (SD) patient age was 71.0 (18.3) years, with a sex ratio of 0.91. In multivariate analyses, predictors of favorable shortterm outcome were age <= 75 years (adjusted odds ratio [aOR] 5.38 [95% confidence interval, 1.59-18.2]), absence of respiratory disease (4.94 [1.01-24.37]), and absence of superinfection (aOR 3.91 [1.37-11.13]). The predictors of ICU admission were age <= 75 years (aOR 3.28 [1.71-6.25]), chronic respiratory disease (aOR 2.49 [1.20-5.19]), and procalcitonin level > 0.25 ng/mL (aOR 4.25 [1.55-11.67]). Predictors of mortality were use of inhaled corticosteroids (2.49 [1.10-5.63]), influenza infection (2.73 [1.27-5.85]), Charlson score >= 5 (5.35 [1.90-15.05]), superinfection (2.54 [1.05-6.18]), and eosinophil count < 50/mu L (4.39 [1.19-16.2]). Certainty of superinfection was significantly associated with mortality (2.23 [1.15-4.3]). Conclusion: Our study revealed that superinfection was significantly related to the outcome, and that virus species affects mortality. These findings emphasize the need for improving the tools used in daily practice to confirm certainty of superinfection and for broader implementation of vaccination of individuals at risk of VRTIs. (C) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

A 57-year-old bisexual man with a history of walking disability for 5 years diagnosed as hysteria, presented paraparesis with extreme neuropathic pain and complicated by pressure sores (Figure 1). Neurological examination showed an absence of tendon reflexes on the lower limbs with a proprioceptive ataxia, hyperesthesia and allodynia. An in-depth examination revealed a pupil motility disorder of the left eye, namely the Argyll Robertson pupil sign (Supplementary Video S1) evocative of a neurosyphilis. Thoraco-abdominal tomography associated with a cerebral and medullar MRI were non-contributive. He was tested negative for HIV with normal vitamins levels. Parameters of cerebrospinal fluid (CSF) analyses were normal. Complementary tests showed a positive VDRL = 1/128 supporting its importance on CSF samples [Marra, 2015Marra C.M. Neurosyphilis.Contin Lifelong Learn Neurol. 2015; 21 ([Cited 2018, 5]): 1714-1728https://doi.org/10.1212/CON.0000000000000250http://www.ncbi.nlm.nih.gov/pubmed/26633785Crossref Scopus (84) Google Scholar]. Moreover T. pallidum PCR was negative while it is deemed to have a better sensitivity than VDRL Harding and Ghanem, 2012Harding A.S. Ghanem K.G. The performance of cerebrospinal fluid treponemal-specific antibody tests in neurosyphilis: a systematic review.Sex Transm Dis. 2012; 39 ([Cited 2018, 5]): 291-297https://doi.org/10.1097/OLQ.0b013e31824c0e62http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00007435-201204000-00009Crossref PubMed Scopus (91) Google Scholar, Vanhaecke et al., 2016Vanhaecke C. Grange P. Benhaddou N. Blanche P. Salmon D. Parize P. et al.Clinical and biological characteristics of 40 patients with neurosyphilis and evaluation of Treponema pallidum nested polymerase chain reaction in cerebrospinal fluid samples.Clin Infect Dis. 2016; 63 ([Cited 2018, 5]): 1180-1186https://doi.org/10.1093/cid/ciw499https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw499Crossref PubMed Scopus (34) Google Scholar. No granuloma or other sign of bone syphilitic infection was described in pathological examination after pressure sore surgery. Nowadays, late neurosyphilis remains a rare entity responsible of variable neurological and psychiatric syndromes Drago et al., 2016Drago F. Merlo G. Ciccarese G. Agnoletti A.F. Cozzani E. Rebora A. et al.Changes in neurosyphilis presentation: a survey on 286 patients.J Eur Acad Dermatol Venereol. 2016; 30 ([Cited 2018, 5]): 1886-1900https://doi.org/10.1111/jdv.13753http://doi.wiley.com/10.1111/jdv.13753Crossref PubMed Scopus (41) Google Scholar, Conde-Sendín et al., 2004Conde-Sendín M.A. Amela-Peris R. Aladro-Benito Y. Maroto A.A.-M. Current clinical spectrum of neurosyphilis in immunocompetent patients.Eur Neurol. 2004; 52 ([Cited 2018, 5]): 29-35https://doi.org/10.1159/000079391https://www.karger.com/Article/FullText/79391Crossref PubMed Scopus (96) Google Scholar. Past sexual behavior of a man having sex with men, as our case, might be one major point to guide the diagnosis. Patient received 24 millions of units of intravenous benzathyl-penicillin during 14 days and progressively recovered after a 6-month follow-up. No funding source.