ABSTRACT
Objetivos Describir las características clínicas y evaluar los factores asociados con la mortalidad de los pacientes adultos con la nueva enfermedad causada por coronavirus 2019 (COVID-19) ingresados a un hospital de referencia nacional de Perú. Métodos Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnóstico de infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2). Se excluyó a quienes ingresaron con prueba rápida serológica positiva al ingreso, sin clínica sugestiva ni imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados Se incluyó un total de 813 adultos, 544 (66,9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61,2 años (desviación estándar: 15) y 575 (70,5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34,1%) y obesidad (25,9%). Los síntomas más frecuentes al ingreso fueron disnea (82,2%) y tos (53,9%). Un total de 114 (14%) pacientes recibieron ventilación mecánica, 38 (4,7%) ingresaron a unidad de cuidados intensivos y 377 (46,4%) fallecieron. Se asociaron a la mortalidad el requerimiento de soporte ventilatorio, el mayor compromiso pulmonar y los marcadores inflamatorios. Encontramos que por cada 10 años que aumentó la edad, el riesgo de morir se incrementó en 32% (riesgo relativo: 1,32; intervalo de confianza 95%: 1,25 a 1,38). Aquellos pacientes que requirieron ingreso a unidad de cuidados intensivos y ventilación mecánica tuvieron 1,39 (intervalo de confianza 95%: 1,13 a 1,69) y 1,97 (intervalo de confianza 95%: 1,69 a 2,29) veces el riesgo de morir, respectivamente. Conclusión La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad, marcadores inflamatorios y compromiso respiratorio.
Objectives To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru. Methods We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively. Conclusion We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Respiration, Artificial/statistics & numerical data , COVID-19/mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Peru/epidemiology , Prospective Studies , Risk Factors , Cohort Studies , Age Factors , Cough/epidemiology , Cough/virology , Dyspnea/epidemiology , Dyspnea/virology , COVID-19/epidemiology , HospitalsABSTRACT
Abstract Background: The SARS-CoV-2 virus may affect both adults and children. Although COVID-19 has a lower prevalence in infancy and has been described as mild, the clinical characteristics may vary, and there is a possibility of complications. The objectives of this study were to describe the clinical and epidemiological aspects of confirmed COVID-19 pediatric cases in the state of Sinaloa, Mexico, during the first 3 months of the pandemic, and children admitted with COVID-19 to a secondary hospital. Methods: This case series includes all patients with SARS-CoV-2 infection confirmed by PCR (polymerase chain reaction) test, identified in the state epidemiological surveillance system (SISVER) between March 1 and May 31, 2020. Confirmed patients admitted to the Sinaloa Pediatric Hospital (HPS) in the same period are also described. Results: Fifty-one children with SARS-CoV-2 were included, of which ten were admitted to the HPS. The median age was 10 years. The more frequent symptoms were fever (78%), cough (67%), and headache (57%). Most cases were mild or asymptomatic. Three patients with comorbidities died. Only four of ten patients identified in HPS were admitted with the diagnosis of possible COVID-19. Conclusions: SARS-CoV-2 infection in children was mostly mild or asymptomatic, and the clinical presentation varied. There is a possibility of complications, especially in children with comorbidities.
Resumen Introducción: El SARS-CoV-2 puede afectar tanto a adultos como a niños. Aunque la COVID-19 presenta menor prevalencia en la infancia y se ha descrito como leve, las características clínicas pueden ser variables y existe la posibilidad de complicaciones. Los objetivos de este estudio fueron describir las características clínicas y epidemiológicas de los casos pediátricos confirmados en el Estado de Sinaloa, México, durante los primeros 3 meses de la pandemia, y de los niños con COVID-19 internados en un hospital de segundo nivel. Métodos: Esta serie de casos incluyó pacientes con infección por SARS-CoV-2 confirmados por prueba de reacción en cadena de la polimerasa (PCR), identificados en el Sistema de Vigilancia Epidemiológica de Enfermedades Respiratorias (SISVER) del 1 de marzo al 31 de mayo de 2020. Se describen también las características de todos los niños confirmados en el Hospital Pediátrico de Sinaloa (HPS) en las mismas fechas. Resultados: Se incluyeron 51 niños con infección por SARS-CoV-2, de los cuales 10 fueron internados en el HPS. La mediana de edad fue de 10 años. Los síntomas más frecuentes fueron fiebre (78%), tos (67%) y cefalea (57%). La mayoría de los casos fueron leves o asintomáticos. Tres pacientes con comorbilidad fallecieron. Solo cuatro de diez pacientes identificados en el HPS ingresaron bajo sospecha de COVID-19. Conclusiones: La infección por SARS-CoV-2 en los niños fue, en su mayoría, asintomática o leve, y la presentación fue variable. Existe la posibilidad de que se produzcan complicaciones, principalmente en niños con comorbilidad.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Cough/epidemiology , Fever/epidemiology , COVID-19/epidemiology , Headache/epidemiology , Severity of Illness Index , Polymerase Chain Reaction , Cough/virology , Asymptomatic Infections/epidemiology , Fever/virology , COVID-19/physiopathology , Headache/virology , Hospitalization , MexicoABSTRACT
Abstract Background: Cystic fibrosis (CF) is a potentially mortal disease characterized by a chronic pulmonary disease with persistent airway infection. Children with this disease are more susceptible to respiratory infections due to the limitation in mucociliary transport and anatomical disruption of the bronchial tree. SARS-CoV-2 causes COVID-19, a respiratory illness related to exacerbations of chronic pulmonary pathologies in children, such as CF and asthma. There are not enough case reports on pediatric patients with SARS-CoV-2 infection and CF, for which we share our experience. Case report: A 22-month-old male patient diagnosed with CF presented in the hospital with cough, fever, and increased respiratory work. The patient received supplemental oxygen and antibiotic and antiviral therapy. Positive results for type B influenza and RT-PCR (reverse transcription-polymerase chain reaction) for SARS-CoV-2 were obtained. Due to the persistence of respiratory difficulty, high-flow therapy was initiated, with a good response. After an episode of hypoxemia, bradycardia, and increased respiratory work secondary to accumulated secretions, orotracheal intubation and invasive mechanical ventilation were performed. The patient evolved with clinical and gasometric improvement. After 10 days of in-hospital antibiotic management with adequate clinical evolution, the patient was discharged to complete oral treatment and home isolation. Conclusions: We present a case of chronic respiratory disease and SARS-CoV-2 infection with severity criteria in a pediatric patient. The evolution was favorable with timely support management and antibiotic therapy in a third-level hospital.
Resumen Introducción: La fibrosis quística es una afección potencialmente mortal caracterizada por enfermedad pulmonar crónica con infección persistente de las vías aéreas. Los niños con esta enfermedad son más susceptibles a infecciones respiratorias debido a la limitación en el transporte mucociliar y la distorsión anatómica del árbol bronquial. El SARS-CoV-2 (coronavirus tipo 2 del síndrome agudo respiratorio grave) es el virus causante de la COVID-19, enfermedad respiratoria que puede estar relacionada con exacerbaciones de patologías pulmonares crónicas en niños, como la fibrosis quística y el asma. No hay suficientes reportes de casos de pacientes pediátricos con infección por SARS-CoV-2 y fibrosis quística, por lo cual se comparte la presente experiencia. Caso clínico: Paciente de sexo masculino de 22 meses de edad con diagnóstico de fibrosis quística que presentó tos, fiebre y aumento en el trabajo respiratorio. A su ingreso se inició manejo con oxígeno suplementario y tratamiento antibiótico y antiviral. Se obtuvo prueba positiva para influenza tipo B y para SARS-CoV-2 por RT-PCR (reacción en cadena de la polimerasa de transcriptasa inversa). Ante un episodio de hipoxemia, bradicardia y mayor trabajo respiratorio, requirió intubación orotraqueal y ventilación mecánica invasiva. El paciente evolucionó con mejoría clínica y gasométrica. Después de 10 días de manejo antibiótico intrahospitalario, con adecuada evolución clínica, egresó para completar tratamiento por vía oral y aislamiento en casa. Conclusiones: Se presenta el caso de un paciente pediátrico con enfermedad respiratoria crónica de base e infección por SARS-CoV-2 con criterios de gravedad. El paciente evolucionó favorablemente con el manejo de soporte oportuno y terapia de antibióticos en un hospital de tercer nivel.
Subject(s)
Humans , Infant , Male , Cystic Fibrosis/complications , COVID-19/physiopathology , Respiration, Artificial , Severity of Illness Index , Risk Factors , Cough/virology , Reverse Transcriptase Polymerase Chain Reaction , Cystic Fibrosis/physiopathology , Fever/virology , COVID-19/diagnosis , COVID-19/therapyABSTRACT
Background: The clinical manifestations, mortality rates, laboratory and imaging findings of SARS-CoV-2 infection are not yet fully elucidated. Aim: To describe the clinical manifestations, imaging and laboratory findings of 164 SARS-CoV-2 (+) patients consulting at an emergency room of a public general hospital in Santiago, Chile. Material and Methods: Review of medical records, imaging and laboratory results of 164 patients aged between 16 and 92 years (57.9% males) consulting at the emergency room between March 12 and April 27, 2020. Results: The most common presenting symptom was dry cough in 47% of patients, followed by headache in 42% and myalgias in 42%. Forty five percent referred contact with an infected patient or having travelled out of town. Thirty-three (20%) required hospital admission and 5% required admission to an intensive care unit. Conclusions: These patients were predominantly young, and their most common symptoms were dry cough, headache and myalgias.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Emergency Service, Hospital , COVID-19/diagnosis , Travel , Chile/epidemiology , Cough/virology , Myalgia/virology , COVID-19/epidemiology , Headache/virology , HospitalizationABSTRACT
RESUMEN La enfermedad del coronavirus 2019 (COVID-19) es poco frecuente en niños y su salud se ve poco comprometida en la mayoría de casos. La presentación clínica más común es tos, fiebre y eritema faríngeo, los casos graves suelen presentarse con taquipnea. El curso de la enfermedad es de una a dos semanas. Los hallazgos de laboratorio son inespecíficos, entre ellos, linfopenia, elevación de la proteína C reactiva y la procalcitonina. En fases iniciales, la radiografía torácica es usualmente normal, y los hallazgos tomográficos más comunes son consolidaciones con signo del halo, vidrio esmerilado y nódulos pequeños, que afectan principalmente las zonas subpleurales. El manejo es sintomático y, en los casos graves, debe estar enfocado a brindar soporte respiratorio. Se recomienda que la manipulación de las secreciones respiratorias sea limitada y que se tengan las mismas precauciones para evitar contaminación que en pacientes adultos.
ABSTRACT COVID-19 is rarely reported in children and they are mildly affected in most cases. The most common clinical presentation of COVID-19 is cough, fever and sore throat; severe cases show tachypnea. The course of the disease is from one to two weeks. Laboratory findings are nonspecific; lymphopenia, elevation of C-reactive protein and procalcitonin have been described. Early chest X-ray is usually normal, and the most common tomographic findings are consolidations with halo, ground-glass opacities and tiny nodules which mainly affects subpleural areas. Management of the disease is supportive; in severe cases, it should be focused on respiratory support. It is recommended to limit the handling of respiratory secretions and to follow the same preventive measures provided to adults.
Subject(s)
Child , Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Cough/epidemiology , Fever/epidemiology , Pneumonia, Viral/physiopathology , Severity of Illness Index , Pharyngitis/epidemiology , Pharyngitis/virology , Tomography, X-Ray Computed , Age Factors , Coronavirus Infections/physiopathology , Cough/virology , Pandemics , Fever/virology , COVID-19ABSTRACT
INTRODUCCIÓN: El personal de salud, entre ellos los médicos, es parte fundamental en primera línea de defensa ante la pandemia de COVID-19, causada por SARS-Cov-2. OBJETIVO: Caracterizar la clínica y evolución de los primeros casos de contagio por coronavirus en médicos de Perú. METODOLOGÍA: Se presentan una serie de seis casos de médicos infectados por coronavirus, con positividad confirmada para COVID-19, mostrando la evolución diaria desde el diagnóstico de la enfermedad, sus principales signos y síntomas, la evolución de los mismos y hasta el desenlace en cada caso. RESULTADOS: De los casos estudiados, cinco fueron hombres, tenían una mediana de edad de 28 años (rango intercuartílico: 27 a 33). Tres de ellos trabajaban más de 12 horas al día en servicios de hospitalización y emergencia; y tres no contaban con mascarilla como método de protección personal. Los síntomas más frecuentes fueron la temperatura axilar superior a 38 grados Celsius, el malestar general, la tos seca y la odinofagia (este último en tres pacientes). En cuanto al diagnóstico con la prueba molecular, tuvo una mediana de tres días de demora (con rango: de 2 a 6 días). Los síntomas que más persistieron fueron la tos seca (presente durante 10 días en cuatro médicos), y la disgeusia como síntoma único, que tuvo la mayor duración (15 días en un solo médico). En los seis casos la evolución fue favorable. Sin embargo, aún se tienen deficiencias para la definición de reincorporación laboral a sus centros hospitalarios. DISCUSIÓN: A pesar de ser un número pequeño de casos, es el primer reporte en personal de salud y que detalla día a día la evolución de los síntomas de COVID-19. Esto puede servir para la salud ocupacional, e incluso como base para la vigilancia y monitorización de los casos en una población mayor.
INTRODUCTION: Health personnel, including physicians, are a fundamental part of the first line of defense against the SARS-CoV-2 pandemic. OBJECTIVE: To characterize the clinical manifestations and course of the first cases of contagion by SARS-CoV-2 in doctors of Peru. METHODOLOGY: We present a series of six cases of doctors infected by SARS-CoV-2, with confirmed positivity for COVID-19, showing the daily evolution from the diagnosis of the disease, its main signs and symptoms, evolution, and until the outcome in each case. RESULTS: Five were men. The median age was 28 years (interquartile range: 27 to 33). In three cases the physician worked more than 12 hours a day in emergency and hospitalization services and not wear a mask at all times. The most frequent symptoms were axillary temperature above 38°C, malaise, dry cough, and odynophagia (the latter in three of the cases). The diagnosis was made at a median of 3 days (interquartile range: 3 to 4 days). The symptoms that persisted the most were dry cough (present during ten days in four doctors). Dysgeusia was the only symptom with the most extended duration (15 days in only one doctor). In the six cases, the course was favorable. However, these doctors found it difficult to return to functions in their hospital centers adequately. DISCUSSION: Despite a small number of cases, it is the first report detailing the evolution of symptoms day by day, which can help for occupational health and even for case surveillance and monitoring.
Subject(s)
Humans , Male , Female , Adult , Physicians , Infectious Disease Transmission, Professional-to-Patient , COVID-19 Testing , COVID-19/physiopathology , Peru , Cough/epidemiology , Cough/virology , Dysgeusia/epidemiology , Dysgeusia/virology , Pandemics , Fever/epidemiology , Fever/virology , COVID-19/diagnosis , COVID-19/transmission , Masks/statistics & numerical dataSubject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/transmission , Coronavirus Infections/transmission , Disease Transmission, Infectious/statistics & numerical data , Infectious Disease Incubation Period , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Respiratory Distress Syndrome, Newborn/epidemiology , Respiratory Distress Syndrome, Newborn/virology , Comorbidity , China/epidemiology , Communicable Disease Control/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Disease Transmission, Infectious/prevention & control , Cough/epidemiology , Cough/virology , Pandemics , Fever/epidemiology , Fever/virology , Myalgia/epidemiology , Myalgia/virology , Betacoronavirus/genetics , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical dataABSTRACT
Objective: To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017. Methods: From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI. Results: We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 (12.9%) of the swabs showed positive for influenza virus, including 88 (11.1%) subtype influenza A/H1N1, 288 (36.4%) subtype influenza A/H3N2, and 415(52.5%) type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough (χ(2)=9.227, P=0.010), wheezing (χ(2)=7.273, P=0.026) and vomiting (χ(2)=8.163, P=0.017), other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan (95%CI: 630.1-746.7) for influenza-negative children; 768.0 Yuan (95%CI: 686.8-849.3) for influenza-positive children and 738.3 Yuan (95%CI: 655.5-821.1) for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (χ(2)=7.237, P=0.028). Conclusion: Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.