RESUMEN
BACKGROUND: This scoping review aimed to characterise definitions used to describe subclinical tuberculosis (TB), estimate the prevalence in different populations and describe the clinical characteristics and treatment outcomes in the scientific literature. METHODS: A systematic literature search was conducted using PubMed. We included studies published in English between January 1990 and August 2022 that defined "subclinical" or "asymptomatic" pulmonary TB disease, regardless of age, HIV status and comorbidities. We estimated the weighted pooled proportions of subclinical TB using a random-effects model by World Health Organization reported TB incidence, populations and settings. We also pooled the proportion of subclinical TB according to definitions described in published prevalence surveys. RESULTS: We identified 29 prevalence surveys and 71 other studies. Prevalence survey data (2002-2022) using "absence of cough of any duration" criteria reported higher subclinical TB prevalence than those using the stricter "completely asymptomatic" threshold. Prevalence estimates overlap in studies using other symptoms and cough duration. Subclinical TB in studies was commonly defined as asymptomatic TB disease. Higher prevalence was reported in high TB burden areas, community settings and immunocompetent populations. People with subclinical TB showed less extensive radiographic abnormalities, higher treatment success rates and lower mortality, although studies were few. CONCLUSION: A substantial proportion of TB is subclinical. However, prevalence estimates were highly heterogeneous between settings. Most published studies incompletely characterised the phenotype of people with subclinical TB. Standardised definitions and diagnostic criteria are needed to characterise this phenotype. Further research is required to enhance case finding, screening, diagnostics and treatment options for subclinical TB.
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Tuberculosis Pulmonar , Humanos , Prevalencia , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/tratamiento farmacológico , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , Tos/epidemiología , Enfermedades Asintomáticas/epidemiología , Antituberculosos/uso terapéuticoRESUMEN
BACKGROUND: The COVID-19 pandemic, ongoing for over 2 years with evolving viral strains, including the highly infectious Omicron variant, underscores the pivotal role of Traditional Chinese Medicine (TCM) in pandemic intervention. Qingfei Paidu Granules (QFPG) are incorporated into the national TCM diagnosis and treatment protocol. This study aims to assess the clinical effectiveness of QFPG combined with nonpharmacological interventions in asymptomatic novel coronavirus infection. MATERIALS AND METHODS: Using a full-group randomized controlled trial, asymptomatic individuals from 3 wards of Fangcang Hospital were randomly assigned to 3 groups, each comprising 150 cases: F1, the nonpharmacological treatment group, receiving only Five Elements Music Therapy and Gongfa Therapy; F2, the comprehensive treatment group, receiving QFPG treatment combined with Five Elements Music Therapy and Gongfa Therapy; and F3, the pharmacological treatment group, receiving only QFPG treatment. The treatment duration for each group was 6 days. Clinical efficacy and safety among different treatment groups were observed, including the conversion time of COVID-19 nucleic acid detection, duration of hospitalization, conversion rate from mild to moderate cases, and occurrence of adverse events. RESULTS: All 450 participants were included and completed the study. The conversion rates on the first day of treatment were 10.7%, 30%, and 11.3% for the F1, F2, and F3 groups, respectively. Compared to F1, both F2 and F3 showed shortened first conversion time and time to double negative results, with first conversion times of 1.92 days for F2 and 2.29 days for F3. Additionally, the time in F2 was shorter compared to F3. Hospitalization duration was shortened in both F2 and F3 compared to F1, with no statistically significant difference between F2 and F3. The conversion rate from mild to moderate cases was lower in both F2 and F3 compared to F1, but the difference between F2 and F3 was not significant. CONCLUSION: Combining QFPG with traditional Chinese nonpharmacological interventions effectively shortened the conversion time of COVID-19 nucleic acid detection and reduced the conversion rate from asymptomatic infection to mild/moderate cases. This treatment approach is worth promoting in the management of asymptomatic patients during pandemics. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR2200059007.
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COVID-19 , Medicamentos Herbarios Chinos , SARS-CoV-2 , Humanos , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos Herbarios Chinos/administración & dosificación , Masculino , Femenino , COVID-19/terapia , Persona de Mediana Edad , Adulto , Medicina Tradicional China/métodos , Tratamiento Farmacológico de COVID-19 , Resultado del Tratamiento , Terapia Combinada , Infecciones Asintomáticas/terapiaRESUMEN
Asymptomatic bacteriuria is common, but usually benign. Inappropriate antimicrobial treatment of asymptomatic bacteriuria contributes to negative antimicrobial outcomes. Optimizing antimicrobial use for bacteriuria is a component of antimicrobial stewardship programs and includes key practices of dissemination and implementation of guidelines, laboratory practices which support stewardship, and programs to monitor and implement optimal antimicrobial treatment for urinary infection. These activities vary in their effectiveness, costs, and complexity to institute. Stewardship strategies targeting unique populations with a high prevalence of bacteriuria and for whom symptom assessment is not straightforward need to be further developed and evaluated to support optimal stewardship.
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Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Bacteriuria , Humanos , Bacteriuria/tratamiento farmacológico , Bacteriuria/diagnóstico , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/métodos , Infecciones Asintomáticas/terapia , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiologíaAsunto(s)
Infecciones Asintomáticas , Infección Hospitalaria , Casas de Salud , Infecciones Estafilocócicas , Humanos , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/prevención & control , Infección Hospitalaria/terapia , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/prevención & control , Infecciones Estafilocócicas/terapia , Infecciones Asintomáticas/terapiaRESUMEN
BACKGROUND: Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms. METHODS: We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone-iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups. RESULTS: Data were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason. CONCLUSIONS: In nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care. (Funded by the Agency for Healthcare Research and Quality; Protect ClinicalTrials.gov number, NCT03118232.).
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Antiinfecciosos Locales , Infecciones Asintomáticas , Clorhexidina , Infección Hospitalaria , Casas de Salud , Povidona Yodada , Humanos , Administración Cutánea , Administración Intranasal , Antiinfecciosos Locales/administración & dosificación , Antiinfecciosos Locales/uso terapéutico , Baños , Clorhexidina/administración & dosificación , Clorhexidina/uso terapéutico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/terapia , Hospitalización/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Povidona Yodada/administración & dosificación , Povidona Yodada/uso terapéutico , Cuidados de la Piel/métodos , Infecciones Asintomáticas/terapiaRESUMEN
Importance: Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective: To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants: A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures: SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures: Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability. Results: Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/µL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/µL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron). Conclusions and Relevance: In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.
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Vacunas contra la COVID-19 , COVID-19 , Vacunación , Carga Viral , Adulto , Femenino , Humanos , Masculino , COVID-19/diagnóstico , COVID-19/genética , COVID-19/prevención & control , COVID-19/virología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/uso terapéutico , Estudios Prospectivos , ARN Viral/análisis , ARN Viral/genética , ADN Polimerasa Dirigida por ARN , SARS-CoV-2/genética , Vacunación/estadística & datos numéricos , Estados Unidos/epidemiología , Carga Viral/efectos de los fármacos , Carga Viral/genética , Carga Viral/estadística & datos numéricos , Secuenciación Completa del Genoma , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , Factores de Tiempo , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunas de ARNmRESUMEN
BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management. METHODS AND FINDINGS: A cross-sectional study of pregnant women assisted in a high-risk maternity hospital in Brazil in 2020. All patients admitted for delivery or miscarriage care were tested for SARS-CoV-2 using polymerase chain reaction (PCR) and for immunoglobulin (I)gM, and/or IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. A total of 265 pregnant women were included in the study. There were 38 (14.4%) PCR positive cases during pregnancy, 12 (31.6%) on admission screening, and 71(27.2%) patients were IgM- and/or IgG-positive. Among the participants, 86 (32.4%) had at least one positive test during pregnancy. SARS-CoV-2 positive patients had greater contact with known positive patients (p = 0.005). The most frequently reported symptoms were runny nose, cough, loss of smell and taste, headache, and fever. There was also a 35% rate of asymptomatic infections and a 4.6% rate of severe or critical infections. Patients exposed or infected with SARS-CoV-2 had a higher incidence of preterm delivery, cesarean section, need for resuscitation in the delivery room, Apgar score <7 at 5 min, admission to the neonatal intensive care unit, and jaundice. Newborns with at least one positive test had a significantly greater need for phototherapy after delivery (p = 0.05). The results showed a high rate of positive tests among newborns (37.5%), which seems to be compatible with both neonatal and perinatal infection. CONCLUSIONS: It is important to further investigate SARS-CoV-2 infection during pregnancy, including the clinical course and the possibility of adverse outcomes with impact on maternal and fetal health, regardless of the development of symptoms.
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COVID-19/epidemiología , Maternidades , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Atención Prenatal , SARS-CoV-2 , Adolescente , Adulto , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , Brasil/epidemiología , COVID-19/terapia , Estudios Transversales , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/terapiaRESUMEN
Importance: Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. Observations: From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception. Conclusions and Relevance: Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.
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Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/etnología , Trazado de Contacto , Farmacorresistencia Microbiana , Minorías Étnicas y Raciales/estadística & datos numéricos , Femenino , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/epidemiología , Gonorrea/etnología , Infecciones por VIH/complicaciones , Infecciones por VIH/transmisión , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Herpes Genital/epidemiología , Herpes Genital/etnología , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Herpes Simple/epidemiología , Herpes Simple/etnología , Humanos , Masculino , Tamizaje Masivo , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/etnología , Mycoplasma genitalium , Técnicas de Amplificación de Ácido Nucleico , Distribución por Sexo , Minorías Sexuales y de Género/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/etnología , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/epidemiología , Sífilis/etnología , Serodiagnóstico de la Sífilis/métodos , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/etnología , Estados Unidos/epidemiologíaRESUMEN
Staphylococcus pseudintermedius is a well-known coagulase-positive staphylococcus that is mainly associated with the asymptomatic colonization of the skin of pets and mucous membranes. Little is still known about the occurrence of S. pseudintermedius in cats. The current study aimed to characterize the isolates of S. pseudintermedius from sick and healthy cats. This was achieved by examining their antibiotic resistance properties, biofilm formation, and genotype differences. Six hundred and seventy-six cats were swabbed (595 healthy and 81 sick cats). Thirty-five distinct S. pseudintermedius isolates from 27 cats were isolated. The prevalence of S. pseudintermedius in healthy and sick cats was 2.49% and 7.61%, respectively. In comparison, MRSP (methicillin-resistant Staphylococcus pseudintermedius) prevalence was 0.12% and 2.98%, respectively. Cats were more frequently colonized with S. pseudintermedius when kept with dogs, regardless of their health condition, with this result being statistically significant. Multidrug resistance was detected in 50%, and 38.46% of S. pseudintermedius isolates from healthy and sick cats, respectively. In contrast, genetic multidrug resistance was detected in 59% and 46.15% cases, respectively. Seven from eight isolated MRSPs were multidrug-resistant. Multi-locus sequence typing (MLST) assigned isolates to 19 types, of which 16 types submitted for the first time to the PubMLST database. The most frequently detected STs (sequence types) were 551 and 71. ST71 and ST551 were mainly isolated from cats with clinical signs of infection. All were MRSPs, regardless of cats' health. These isolates were characterized with the most frequent antibiotic resistance at the phenotypic and genotypic level.
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Infecciones Asintomáticas/epidemiología , Enfermedades de los Gatos/epidemiología , Staphylococcus/aislamiento & purificación , Animales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Infecciones Asintomáticas/terapia , Enfermedades de los Gatos/tratamiento farmacológico , Enfermedades de los Gatos/microbiología , Gatos , Farmacorresistencia Bacteriana Múltiple/genética , Femenino , Masculino , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Polonia/epidemiología , Staphylococcus/genéticaRESUMEN
BACKGROUND: Selectively targeting and treating malaria-infected individuals may further decrease parasite carriage in low-burden settings. Using a trans-disciplinary approach, a reactive treatment strategy to reduce Plasmodium falciparum prevalence in participating communities was co-developed and tested. METHODS: This is a 2-arm, open-label, cluster-randomized trial involving villages in Central Gambia during the 2017 and 2018 malaria transmission season. Villages were randomized in a 1:1 ratio using a minimizing algorithm. In the intervention arm, trained village health workers delivered a full course of pre-packed dihydroartemisinin-piperaquine to all residents of compounds where clinical cases were reported while in the control arm, compound residents were screened for infection at the time of the index case reporting. All index cases were treated following national guidelines. The primary endpoint was malaria prevalence, determined by molecular methods, at the end of the intervention period. RESULTS: The trial was carried out in 50 villages: 34 in 2017 and 16 additional villages in 2018. At the end of the 2018 transmission season, malaria prevalence was 0.8% (16/1924, range 0-4%) and 1.1% (20/1814, range 0-17%) in the intervention and control arms, respectively. The odds of malaria infection were 29% lower in the intervention than in the control arm after adjustment for age (OR 0.71, 95% CI 0.27-1.84, p = 0.48). Adherence to treatment was high, with 98% (964/979) of those treated completing the 3-day treatment. Over the course of the study, only 37 villages, 20 in the intervention and 17 in the control arm, reported at least one clinical case. The distribution of clinical cases by month in both transmission seasons was similar and the odds of new clinical malaria cases during the trial period did not vary between arms (OR 1.04, 95% CI 0.57-1.91, p = 0.893). All adverse events were classified as mild to moderate and resolved completely. CONCLUSION: The systematic and timely administration of an anti-malarial treatment to residents of compounds with confirmed malaria cases did not significantly decrease malaria prevalence and incidence in communities where malaria prevalence was already low. Treatment coverage and adherence was very high. Results were strongly influenced by the lower-than-expected malaria prevalence, and by no clinical cases in villages with asymptomatic malaria-infected individuals. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, NCT02878200. Registered 25 August 2016. https://clinicaltrials.gov/ct2/show/NCT02878200 .
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Antimaláricos/administración & dosificación , Artemisininas/administración & dosificación , Malaria Falciparum/prevención & control , Quinolinas/administración & dosificación , Autoadministración/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , Niño , Preescolar , Análisis por Conglomerados , Combinación de Medicamentos , Femenino , Gambia/epidemiología , Humanos , Incidencia , Lactante , Malaria Falciparum/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
With ongoing research, it was found that asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was widespread in coronavirus disease 2019 (COVID-19) populations. Studies have confirmed asymptomatic patients with COVID-19 have potential infectivity, and most of the transmission occurred before symptoms appear. Asymptomatic infection rates varied widely in different countries and regions. Identifying the asymptomatic infected persons and cutting off the infection source is an effective way to prevent the spread of this disease. However, asymptomatic patients have hidden clinical symptoms, and screening based only on the clinical symptoms of COVID-19 can easily lead to a missed diagnosis. Therefore, determining asymptomatic infection patients by SARS-CoV-2 nucleic acid testing is the gold standard. A series of prevention and control measures adopted by the Chinese government, especially the "Four Early" policy, have achieved outstanding achievements, which are worth learning from by other countries.
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Infecciones Asintomáticas/epidemiología , COVID-19/epidemiología , Infecciones Asintomáticas/terapia , COVID-19/transmisión , COVID-19/virología , China/epidemiología , Humanos , SARS-CoV-2/aislamiento & purificación , SARS-CoV-2/patogenicidadRESUMEN
The BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) is being utilised internationally for mass COVID-19 vaccination. Evidence of single-dose protection against symptomatic disease has encouraged some countries to opt for delayed booster doses of BNT162b2, but the effect of this strategy on rates of asymptomatic SARS-CoV-2 infection remains unknown. We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection amongst healthcare workers (HCWs) during the UK's first wave of the COVID-19 pandemic, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and find a fourfold reduction in asymptomatic infection amongst HCWs ≥12 days post-vaccination. These data provide real-world evidence of short-term protection against asymptomatic SARS-CoV-2 infection following a single dose of BNT162b2 vaccine, suggesting that mass first-dose vaccination will reduce SARS-CoV-2 transmission, as well as the burden of COVID-19 disease.
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Vacunas contra la COVID-19/uso terapéutico , COVID-19/prevención & control , Infecciones Asintomáticas/terapia , Vacuna BNT162 , COVID-19/diagnóstico , Vacunas contra la COVID-19/administración & dosificación , Personal de Salud , Humanos , Esquemas de Inmunización , Inmunización Secundaria , SARS-CoV-2/aislamiento & purificación , VacunaciónAsunto(s)
Prueba Serológica para COVID-19 , COVID-19/diagnóstico , SARS-CoV-2/aislamiento & purificación , Saliva/virología , Manejo de Especímenes/métodos , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , COVID-19/epidemiología , COVID-19/prevención & control , Prueba Serológica para COVID-19/economía , Prueba Serológica para COVID-19/métodos , Análisis Costo-Beneficio , Transmisión de Enfermedad Infecciosa/prevención & control , Necesidades y Demandas de Servicios de Salud , Humanos , Estándares de Referencia , Reproducibilidad de los Resultados , SARS-CoV-2/inmunología , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture. METHODS: Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. PRIMARY OUTCOME: early-PJI after HHA. RESULTS: Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33-3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15-7.10]). CONCLUSIONS: Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Bacteriuria/microbiología , Artropatías/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Asintomáticas/terapia , Bacteriuria/tratamiento farmacológico , Bacteriuria/etiología , Femenino , Fosfomicina/uso terapéutico , Humanos , Artropatías/tratamiento farmacológico , Artropatías/etiología , Masculino , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/etiología , Trometamina/uso terapéuticoRESUMEN
BACKGROUND: COVID-19 can be asymptomatic in a substantial proportion of patients. The assessment and management of these patients constitute a key element to stop dissemination. AIM: To describe the assessment and treatment of asymptomatic infection in patients with a confirmed diagnosis of COVID-19. METHODS: We searched five databases and search engines for preprints/preproofs, up to August 22, 2020. We included cohort, cross-sectional, and case series studies, reporting the assessment and management of asymptomatic individuals. We extracted data on total discharges with negative PCR, length of hospitalization, treatment, and number of patients who remained asymptomatic. A random-effects model with inverse variance method was used to calculate the pooled prevalence. RESULTS: 41 studies (nine cross-sectional studies, five retrospective studies and 27 reports/case series; 647 asymptomatic individuals), were included, of which 47% were male (233/501). The age of patients was between 1month and 73 years. In patients who became symptomatic, length of hospitalization mean was 13.6 days (SD 6.4). Studies used lopinavir/ritonavir, hydroxychloroquine plus ritonavir/lopinavir, hydroxychloroquine with and without azithromycin, ribavirin plus interferon and interferon alfa. The proportion of individuals who remained asymptomatic was 91% (463/588 patients; 95%CI: 78.3%-98.7%); and asymptomatic individuals discharged with negative PCR was 86% (102/124 individuals; 95%CI: 58.4%-100%). CONCLUSIONS: There is no standard treatment for asymptomatic COVID-19 individuals. There are no studies of adequate design to make this decision. It has been shown that most asymptomatic individuals who were followed have recovered, but this cannot be attributed to standard treatment.
Asunto(s)
Infecciones Asintomáticas/terapia , Tratamiento Farmacológico de COVID-19 , COVID-19/diagnóstico , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , Prueba de Ácido Nucleico para COVID-19/métodos , Niño , Preescolar , Quimioterapia Combinada , Femenino , Hospitalización , Humanos , Hidroxicloroquina/uso terapéutico , Lactante , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Ritonavir/uso terapéutico , SARS-CoV-2/aislamiento & purificación , Adulto JovenRESUMEN
OBJECTIVE: Several factors raise concern for increased risk of COVID-19 in cancer patients. While there is strong support for testing symptomatic patients. The benefit of routine testing of asymptomatic patients remains contentious. We aim to evaluate the prevalence of asymptomatic COVID-19 infection in cancer patients. METHODS: Between June 1 and September 3, 2020, we obtained nasopharyngeal swab from asymptomatic cancer patients who were visiting a single tertiary-care cancer center, and tested the specimen for the presence or absence of SARS-CoV-2 RNA. We performed a descriptive statistic of data RESULTS: We tested a total of 80 patients, of which 3 (3.75%) were found positive for COVID-19. A significant proportion of the tested patients were on active immunosuppressive or immunomodulatory treatment, cytotoxic chemotherapy (nâ¯=â¯34), and immunotherapy (nâ¯=â¯16). However, all three COVID-19 positive patients were only actively on hormonal therapy. All three patients observed a minimum of 2 weeks home quarantine. None of the patients developed symptoms upon follow up and no changes were required to their treatment plan. CONCLUSIONS: Despite published evidence that cancer patients may be at increased risk of severe COVID -19 infection, our data suggest that some infected cancer patients are asymptomatic. The overall prevalence of asymptomatic COVID-19 infection in this population of cancer patients was similar to that in the general population. Therefore, since asymptomatic infections are not uncommon in patients with cancer, we recommend universal COVID-19 testing to help guide treatment decisions and prevent the spread of the disease.
Asunto(s)
Infecciones Asintomáticas/terapia , COVID-19/prevención & control , Neoplasias/terapia , SARS-CoV-2/aislamiento & purificación , Centros de Atención Terciaria , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas/epidemiología , COVID-19/diagnóstico , COVID-19/virología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/epidemiología , Ciudad de Nueva York/epidemiología , Pandemias , Prevalencia , Estudios Prospectivos , ARN Viral/análisis , ARN Viral/genética , SARS-CoV-2/genética , SARS-CoV-2/fisiologíaRESUMEN
OBJECTIVES: Although current guidelines advice to screen for asymptomatic bacteriuria during pregnancy, little is known about the best moment of testing. The goal of this study is to analyze the optimal timing (first vs. second trimester) to screen for asymptomatic bacteriuria during pregnancy. METHODS: A retrospective cohort analysis, comparing patients that were screened for asymptomatic bacteriuria in the first vs. second trimester was performed. The main question was to compare the rate of positive urinary culture in both trimesters. Study included patients all followed a prenatal consultation at the University Hospital of Brussels between 2012 and 2017. Other outcomes considered were the nature of identified germs, treatments, possible risk and confounding factors (age, BMI, gravidity-parity-abortus [GPA], type of conception, ethnicity, education, prior urinary tract infection (UTI), diabetes, hypertension, prior preterm delivery and sickle cell disease) and complications (UTI, preterm delivery, preterm rupture of the membranes and chorio-amnionitis). RESULTS: A total of 2,005 consecutive files were reviewed, 655 concerned patients screened during the first trimester group and 1,350 in the second trimester group. Asymptomatic bacteriuria was present in only 71 cases (3.54%), 23 in the first trimester group (3.50%) and 48 in the second trimester group (3.55%). Escherichia coli was the most frequently identified germ (37 cases (1.8%), 14 in the first trimester group and 23 in the second trimester group). Our logistic regression analysis shows no statistical difference according to the moment the urinary culture was done for the presence of asymptomatic bacteriuria (E. coli or others), for its association with hospitalization for pyelonephritis, preterm contractions, preterm pre-labor rupture of the membranes (PPROM) and/or preterm delivery. CONCLUSIONS: If recommendations remain to screen for asymptomatic bacteriuria at least once during pregnancy, this study indicates that the moment of testing (first vs. second trimester) has no clinical impact on obstetrical outcomes.
Asunto(s)
Infecciones Asintomáticas , Bacteriuria , Complicaciones del Trabajo de Parto , Diagnóstico Prenatal , Urinálisis/métodos , Adulto , Infecciones Asintomáticas/epidemiología , Infecciones Asintomáticas/terapia , Bacteriuria/complicaciones , Bacteriuria/diagnóstico , Bacteriuria/microbiología , Bélgica/epidemiología , Estudios de Cohortes , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Complicaciones del Trabajo de Parto/etiología , Complicaciones del Trabajo de Parto/prevención & control , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo , Resultado del Embarazo/epidemiología , Trimestres del Embarazo , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal/normas , Tiempo de Tratamiento/normasRESUMEN
BACKGROUND: Many refugees and asylum seekers from countries where schistosomiasis is endemic are infected with the Schistosoma parasite when they arrive in Canada. We assessed, from a systemic perspective, which of the following management strategies by health care providers is cost-effective: testing for schistosomiasis and treating if the individual is infected, treating presumptively or waiting for symptoms to emerge. METHODS: We constructed a decision-tree model to examine the cost-effectiveness of 3 management strategies: watchful waiting, screening and treatment, and presumptive treatment. We obtained data for the model from the literature and other sources, to predict deaths and chronic complications caused by schistosomiasis, as well as costs and net monetary benefit. RESULTS: Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.1%. In our baseline analysis, presumptive treatment was associated with an increase of 0.156 quality-adjusted life years and a cost saving of $405 per person, compared with watchful waiting. It was also more effective and less costly than screening and treatment. INTERPRETATION: Among recently resettled refugees and asylum claimants in Canada, from countries where schistosomiasis is endemic, presumptive treatment was predicted to be less costly and more effective than watchful waiting or screening and treatment. Our results support a revision of the current Canadian recommendations.
Asunto(s)
Antihelmínticos/uso terapéutico , Praziquantel/uso terapéutico , Refugiados , Esquistosomiasis/diagnóstico , Esquistosomiasis/tratamiento farmacológico , Antihelmínticos/economía , Infecciones Asintomáticas/terapia , Canadá , Análisis Costo-Beneficio , Árboles de Decisión , Humanos , Tamizaje Masivo/economía , Praziquantel/economía , Prevalencia , Años de Vida Ajustados por Calidad de Vida , Esquistosomiasis/economía , Esquistosomiasis/epidemiología , Espera Vigilante/economíaRESUMEN
BACKGROUND: Cardiac hydatid cyst is a rare parasitic disease. Since it may be associated with fatal complications, early diagnosis and treatment of a cardiac hydatid cyst is very important, however, it may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. CASE PRESENTATION: We report a case of a young asymptomatic boy, who underwent a routine chest x ray in a pre employment check up in whom we discovered a multiple pulmonary lesions and a right ventricle hydatid cyst. He then underwent a successful treatment CONCLUSION: Due to the high risk of associated complications, cardiac hydatid cysts should be removed surgically, even in asymptomatic patients.
Asunto(s)
Infecciones Asintomáticas , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis/diagnóstico por imagen , Cardiopatías/parasitología , Hallazgos Incidentales , Infecciones Asintomáticas/terapia , Equinococosis/cirugía , Equinococosis Pulmonar/cirugía , Cardiopatías/cirugía , Humanos , Masculino , Adulto JovenRESUMEN
The impact of different types of reactive case detection and/or treatment strategies for malaria elimination depends on high coverage and participants' adherence. However, strategies to optimise adherence are limited, particularly for people with asymptomatic or no infections. As part of a cluster-randomized trial to evaluate the effect of reactive treatment in The Gambia, all residents in the compound of a diagnosed clinical malaria patient received dihydro-artemisinin-piperaquine (DP). Using a mixed method approach, we assessed which factors contribute to adherence among the contacts of malaria cases that showed no symptoms. Adherence was defined as the proportion of compound members that (1) returned all medicine bags empty and (2) self-reported (3-day) treatment completion. Among the 273 individuals from 14 compounds who received DP, 227 (83.1%) were available for and willing to participate in the survey; 85.3% (233/273) returned empty medicine bags and 91.6% (208/227) self-reported treatment completion. Although clinical malaria was not considered a major health problem, reported adherence was high. The drivers of adherence were the strong sense of responsibility towards protecting the individual, compound and the village. Adherence can be optimised through a transdisciplinary implementation research process of engaging communities to bridge the gap between research goals and social realities.