PP19 -The occurrence of morbidity and mortality among patients experiencing respiratory symptoms at Teaching Hospital, Kurunegala, in April 2024

Abstract

Introduction

Respiratory tract infections (RTIs) remain a major global health burden, contributing to significant morbidity and mortality across all age groups. Their etiology includes viral, bacterial, and fungal pathogens, with outbreaks often influenced by seasonal patterns and environmental factors. This study investigates an increased incidence of RTIs among patients admitted to the Teaching Hospital in Kurunegala between the second and fourth weeks of April 2024. The study aims to identify contributing factors, determine causative agents, assess clinical presentations, and evaluate management and preventive strategies.

Design, setting, and methods

This observational study was conducted at the Teaching Hospital in Kurunegala and the Medical Research Institute (MRI) in Colombo, Sri Lanka. It included patients presenting with severe acute respiratory distress or those who developed respiratory complications during hospitalization. Respiratory specimens underwent bacterial culture, antibiotic sensitivity testing, and molecular diagnostics (real-time PCR and respiratory multiplex PCR) to identify viral and bacterial pathogens. Fungal testing was performed selectively. All laboratory assays followed strict quality control measures, and results were promptly shared with clinicians for timely intervention.

Results

Of the 12 patients analyzed, 7/12 were over 60 years old, and 10/12 had pre-existing comorbidities. The most common symptoms included fever, cough, and shortness of breath. Mechanical ventilation was required in 7/12 patients, and 8/12 patients succumbed to the illness. Laboratory findings revealed SARS-CoV-2 in 4 of 12 patients, influenza A in 2 of 12, and Parainfluenza 1 in 1 of 12. One patient had a secondary bacterial (Staphylococcus aureus) and fungal (Candida spp.) co-infection. Oseltamivir was administered to 7 of 12 patients, but no SARS-CoV-2-specific antiviral treatments were administered.

Conclusion

This investigation highlights the critical impact of respiratory tract infections among elderly and comorbid patients during the April 2024 outbreak at the Teaching Hospital in Kurunegala. The predominance of SARS-CoV-2 and influenza A, along with a high requirement for mechanical ventilation and a mortality rate of 67%, underscores the severity of these infections in vulnerable populations. The lack of SARS-CoV-2-specific antiviral therapy and delayed clinical recognition likely contributed to the poor outcomes. Furthermore, the absence of pathogen detection in postmortem samples emphasizes the need to strengthen specimen collection protocols and enhance diagnostic capabilities. Strengthening surveillance systems, ensuring timely access to laboratory testing, and optimizing therapeutic interventions are vital to reducing morbidity and mortality in future outbreaks.