Cleveland Clinic Journal of Medicine最新文献

Viral respiratory diseases affect millions of individuals worldwide each year. Annual vaccinations are recommended by the World Health Organization for some of them, such as influenza and more recently for the coronavirus disease of 2019 (COVID-19) and respiratory syncytial virus, with the goal of reducing disease severity and limiting transmission. In the context of infection and vaccination, it is of primary importance to evaluate the immune response to pathogens to shed light on the mechanisms of protection.

Respiratory syncytial virus (RSV) is a significant cause of morbidity and mortality in infants, older adults, and patients with weakened immune systems. Disease severity differs by underlying immunologic pathologies, with worse outcomes associated with progression from upper to lower respiratory disease. In this review we address the impact of RSV in immunocompromised populations, and discuss the limited available treatments and the potential impact of newer RSV prevention strategies on immunocompromised adults and children.

Testing for respiratory viruses has changed greatly over the past decade, owing to advances in technology, drug development, vaccine research, and a growing recognition of the importance of improving patient access. Here, we focus on the most common respiratory viruses and review preanalytic variables (eg, collection and storage) that affect test results, testing methods including nucleic acid amplification testing (NAAT), and controversies, challenges, and trends in diagnostic testing relevant to clinicians.

Respiratory syncytial virus (RSV) is a threat to infants globally causing bronchiolitis and pneumonia. Despite decades of research, RSV outbreaks occur with only modest advancements in prevention or treatment. Vaccine development faced challenges because past attempts caused enhanced disease and treatment options demonstrated limited efficacy. Recent advancements, including maternal vaccines focusing on the prefusion form of the F glycoprotein are now showing significant benefits in preventing severe RSV-related illness in infants. Additionally, monoclonal antibodies offer prevention directly to newborns within 1 week of birth. These innovations have the potential to substantially change the impact of RSV.

Vaccination is a cornerstone of public health, but vaccine hesitancy poses significant challenges as highlighted during the COVID-19 pandemic. Addressing the challenge requires healthcare professionals to effectively counter misinformation. They have a pivotal role in fostering trust and promoting evidence-based vaccine recommendations, with tailored communication strategies and community engagement initiatives. Legislation, policy interventions, research, innovation, and technology are needed to enhance vaccine uptake and ensure equitable access. Integration of vaccination into routine healthcare is paramount for public health protection against emerging infectious threats.

The new vaccines against respiratory syncytial virus (RSV) reduce the risk of RSV illness, which is common in older people and carries the risk of hospitalization with its attendant risks such as delirium and physical decline leading to loss of function and independence. Individualized discussions regarding vaccination should weigh the risks of vaccination, which are minor, against the preventive benefits. Discussions incorporating these elements may lead to greater vaccine uptake, especially by those at high risk.

In 2023 and 2024, 3 vaccines were approved by the US Food and Drug Administration (FDA) against respiratory syncytial virus (RSV) in adults. In addition, the first long-acting RSV monoclonal antibody for infants and young children was approved. This review provides clinicians with practical guidance to navigate this new era of RSV prevention.

Primary adrenal insufficiency is rare but serious; it puts patients at risk of acute decompensation and adrenal crisis due to insufficient cortisol and aldosterone production. Further, its diagnosis is often delayed, or it is mistaken for secondary adrenal insufficiency, which can have life-threatening consequences. Early recognition and appropriate treatment can greatly improve patient outcomes and quality of life.