A 2010 study examining co-infection of influenza in co-housed ferret pairs found that the influenza increased both incidence and severity of pneumococcal infection. These findings exhibited pneumococcal strain dependence. A separate 2010 study examining intra-litter transmission, with influenza co-infection in infant mice, found that the influenza co-infection is a facilitator for pneumococcal susceptibility, transmission, and disease via bacterial shedding. A third study of note, from 2016, was able to examine pneumococcal transmission without co-infection of an URT infection. This study utilized intra-litter transmission in infant mice during bacterial mono-infection with pneumococcus. The results of this study indicated higher rates of shedding for infections in younger mice. These studies, along with the animal models that they utilize have enhanced our understanding of the transmission of pneumococcus. Inflammation induced by Influenza A Virus (IAV) stimulates the flow of mucus through the expression of glycoproteins, prompts secretion, and increases shedding. Streptococcus is found in the inflammation-generated mucus layers covering the URT and increased pneumococci are observed in nasal secretions with IAV co-infection. Levels of shedding have correlations with IAV induced URT inflammation. Pro-inflammatory effects are exhibited by the single pneumococcal toxin, pneumolysin (Ply); use of anti-Ply antibodies result in decreased inflammation. Studies have found transmissible levels of bacterium only in young mice, exhibiting that shedding increases with incidences of contact and proximity. Shedding is shown to decrease in the presence of agglutinating antibodies such as IgG and IgA1 unless cleavage occurs via an IgA1-specific pneumococcal protease.
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Management
When fat necrosis is being felt by a physician or patient, it may feel larger, smaller, unchanged, or not felt at all (resolved). Fat necrosis usually does not require surgery, it usually requires a patient to meet with their physician and as long as the pain is not present there is nothing to be concerned about unless the patient is concerned about cosmetic abnormalities. However, if pain is present surgery is a form of treatment a patient can consider. To keep track of benign fat necrosis a yearly mammogram is taken in order to observe it. However, if fat necrosis consists of oily fluid a physician will go in with a needle to remove this liquid, which may be causing discomfort. Excision may be needed if the mass becomes solid or causes a cosmetic abnormality. Prognosis
Although getting diagnosed with fat necrosis of any kind can be a great cause for concern, as most individuals may mistake it for a malignant tumor. Fat necrosis of the breast is a prognosis that is benign and does not increase an individuals risk for various cancers. An individuals life expectancy does not decrease with this diagnosis. Epidemiology
Fat necrosis in the breast occurs around 0.6%, this represents 2.75% of lesions that end up being benign. However, 0.8% of fat necrosis occurs from tumors of the breast, 1% - 9% occurs in breast reduction surgery. Individuals that are high risk include women around the age of 50yrs along with pendulous breasts.