ABSTRACT
Early kinetics of SARS-CoV-2 viral load (VL) in plasma determined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) was evaluated as a predictor of poor clinical outcome in a prospective study and assessed in a retrospective validation cohort. Prospective observational single-center study including consecutive adult patients hospitalized with COVID-19 between November 2020 and January 2021. Serial plasma samples were obtained until discharge. Quantitative RT-PCR was performed to assess SARS-CoV-2 VL. The main outcomes were in-hospital mortality, admission to the Intensive Care Unit (ICU), and their combination (Poor Outcome). Relevant viremia (RV), established in the prospective study, was assessed in a retrospective cohort including hospitalized COVID-19 patients from April 2021 to May 2022, in which plasma samples were collected according to clinical criteria. Prospective cohort: 57 patients were included. RV was defined as at least a twofold increase in VL within ≤2 days or a VL > 300 copies/ml, in the first week. Patients with RV (N = 14; 24.6%) were more likely to die than those without RV (35.7% vs. 0%), needed ICU admission (57% vs. 0%) or had Poor Outcome (71.4% vs. 0%), (p < 0.001 for the three variables). Retrospective cohort: 326 patients were included, 18.7% presented RV. Patients with RV compared with patients without RV had higher rates of ICU-admission (odds ratio [OR]: 5.6 [95% confidence interval [CI]: 2.1-15.1); p = 0.001), mortality (OR: 13.5 [95% CI: 6.3-28.7]; p < 0.0001) and Poor Outcome (OR: 11.2 [95% CI: 5.8-22]; p < 0.0001). Relevant SARS-CoV-2 viremia in the first week of hospitalization was associated with higher in-hospital mortality, ICU admission, and Poor Outcome. Findings observed in the prospective cohort were confirmed in a larger validation cohort.
Subject(s)
COVID-19 , Adult , COVID-19/diagnosis , Hospitalization , Humans , Prospective Studies , Retrospective Studies , SARS-CoV-2 , ViremiaABSTRACT
Antibody detection is essential to establish exposure, infection, and immunity to SARS-CoV-2, as well as to perform epidemiological studies. The worldwide urge for new diagnostic tools to control the pandemic has led to a quick incorporation in clinical practice of the recently developed serological assays. However, as only few comparative studies have been published, there is a lack of data about the diagnostic accuracy of currently available assays. We evaluated the diagnostic accuracy to detect Ig G, Ig M+A, and/or IgA anti SARS-CoV-2 of 10 different assays: lateral flow card immunoassays, 4 enzyme-linked immunosorbent assay (ELISA), and 3 chemiluminescent particle immunoassays (CMIA). Using reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 as gold standard, sensitivity, specificity, PPV, and NPV were determined. Each assay was tested in 2 groups, namely, positive control, formed by 50 sera from 50 patients with SARS-CoV-2 pneumonia with positive RT-PCR; and negative control, formed by 50 sera from 50 patients with respiratory infection non-COVID-19. Sensitivity range of the 10 assays evaluated for patients with positive COVID-19 RT-PCR was 40-77% (65-81% considering IgG plus IgM). Specificity ranged 83-100%. VPP and VPN were respectively 81-100% and 61.6-81%. Among the lateral flow immunoassays, the highest sensitivity and specificity results were found in Wondfo® SARS-CoV-2 Antibody Test. ELISA IgG and IgA from EUROIMMUN® were the most sensitive ELISA. However, poor results were obtained for isolated detection of IgG. We found similar sensitivity for IgG with SARS-CoV-2 for Architect by Abbott® and ELISA by Vircell®. Results obtained varied widely among the assays evaluated. Due to a better specificity, overall diagnostic accuracy of the assays evaluated was higher in case of positive result. On the other side, lack of antibody detection should be taken with care because of the low sensitivity described. Highest diagnostic accuracy was obtained with ELISA and CMIAs, but they last much longer.
Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing/methods , COVID-19/diagnosis , SARS-CoV-2/isolation & purification , Adult , Aged , COVID-19/blood , COVID-19 Nucleic Acid Testing/standards , Female , Humans , Immunoassay/methods , Immunoglobulin Isotypes/blood , Immunoglobulin Isotypes/immunology , Male , Middle Aged , SARS-CoV-2/immunology , Sensitivity and SpecificityABSTRACT
AIM: To assess the respective performances of a HCV screening program in a hospital setting and a HCV screening model applied concomitantly in a primary care centre. METHODS: Adult patients consecutively admitted to hospital for ambulatory surgery were screened for anti-HCV antibodies (hospital screening cohort, HPSC), as were patients receiving blood tests for medical reasons in a primary care centre (primary care screening cohort, PCSC). Serum anti-HCV and HCV RNA levels were tested by ELISA and real-time PCR, respectively. RESULTS: Seroprevalence of HCV infection was 2.2 % in the HPSC and 1.4 % in the PCSC (p = 0.044). All viraemic patients (0.2 % in HPSC and 0.1 % in PCSC) were treated with direct-acting antivirals and 85.7 % experienced a sustained virological response. CONCLUSIONS: Hospital-based HCV screening outperformed primary care-centered screening, significantly increasing HCV case findings.
Subject(s)
Hepatitis C, Chronic , Hepatitis C , Adult , Humans , Hepacivirus/genetics , Antiviral Agents/therapeutic use , Seroepidemiologic Studies , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hospitals , Hepatitis C Antibodies/therapeutic use , Primary Health CareABSTRACT
BACKGROUND: SARS-CoV-2 viral load and kinetics assessed in serial blood samples from hospitalised COVID-19 patients by RT-PCR are poorly understood. METHODS: We conducted an observational, prospective case series study in hospitalised COVID-19 patients. Clinical outcome data (Intensive Care Unit admission and mortality) were collected from all patients until discharge. Viremia was determined longitudinally during hospitalisation, in plasma and serum samples collected sequentially, using two commercial and standardised RT-PCR techniques approved for use in diagnosis of SARS-CoV-2. Viral load (copies/mL and log10) was determined with quantitative TaqPath™COVID-19 test. Persistent viremia (PV) was defined as two or more consecutive quantifiable viral loads detected in blood samples (plasma/serum) during hospitalisation. RESULTS: SARS-CoV-2 viremia was studied in 57 hospitalised COVID-19 patients. PV was detected in 16 (28%) patients. All of them, except for one who rapidly progressed to death, cleared viremia during hospitalisation. Poor clinical outcome occurred in 62.5% of patients with PV, while none of the negative patients or those with sporadic viremia presented this outcome (p < 0.0001). Viral load was significantly higher in patients with PV than in those with Sporadic Viremia (p < 0.05). Patients presented PV for a short period of time: median time from admission was 5 days (Range = 2-12) and 4.5 days (Range = 2-8) for plasma and serum samples, respectively. Similar results were obtained with all RT-PCR assays for both types of samples. CONCLUSIONS: Detection of persistent SARS-CoV-2 viremia, by real time RT-PCR, expressed as viral load over time, could allow identifying hospitalised COVID-19 patients at risk of poor clinical outcome.
Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/diagnosis , Humans , Kinetics , Prospective Studies , RNA, Viral , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Viral Load , Viremia/diagnosisABSTRACT
Presence of SARS-CoV-2 RNA in serum (viremia) of COVID-19 patients has been related to poor prognosis and death. The aim of this study was to evaluate both the ability to detect viremia in COVID-19 patients of two commercial reverse real-time-PCR (rRT-PCR) tests, Cobas® and TaqPath™, comparing them with a gold standard method, and their implementation in microbiology laboratories. This retrospective cohort study included 303 adult patients (203 diagnosed with COVID-19 and 100 non-COVID-19 patients) admitted to a tertiary hospital, with at least one serum sample collected within the first 48 h from admission. A total of 365 serum samples were included: 100 from non-COVID patients (pre-pandemic and pandemic control groups) and 265 from COVID-19 patients. Serum samples were considered positive when at least one target was detected. All patients in control groups showed negative viremia. Cobas® and TaqPath™ tests showed specificity and Positive Predictive Value over 96%. Nevertheless, sensitivity (53.72 and 73.63, respectively) and Negative Predictive Value (64.78 and 75) were lower. Viremia difference between ICU and non-ICU patients was significant (p ≤ 0.001) for both techniques. Consequently, SARS-CoV-2 viremia detection by both rRT-PCR tests should be considered a good tool to stratify COVID-19 patients and could be implemented in microbiology laboratories.
Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Humans , RNA, Viral/genetics , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Sensitivity and SpecificityABSTRACT
PURPOSE: Describing the utility of Polymerase Chain Reaction for Cytomegalovirus (CMV-PCR) in the diagnosis of suspected viral anterior uveitis (AU). PATIENTS AND METHODS: We analyzed aqueous humor (AH) CMV-PCR positivity and treatment modifications in 47 eyes of 46 patients with viral uveitis and its correlation with high intraocular pressure (HIOP), uveitis clinical characteristics and time intervals from samples to uveitis diagnosis and to relapse. RESULTS: CMV-PCR positive results occurred in 13 eyes (27.7%) of 12 patients. They were more frequent in HIOP eyes (34.2%, p = 0.047) and with Posner-Schlossman Syndrome (56.2%, p = 0.002). CMV-PCR positivity (p = 0.001) and HIOP (p = 0.038) increased the probability of treatment change. Although CMV-PCR positive results decreased over time (p = 0.002), they were not related to activity or proximity to inflammatory uveitis episode. CONCLUSION: HIOP AU eyes should be considered for CMV-PCR AH analysis due to possible treatment modifications.
Subject(s)
Aqueous Humor/virology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/genetics , DNA, Viral/analysis , Eye Infections, Viral/diagnosis , Polymerase Chain Reaction/methods , Uveitis, Anterior/diagnosis , Adult , Aged , Aged, 80 and over , Cytomegalovirus Infections/virology , Eye Infections, Viral/virology , Female , Humans , Male , Middle Aged , Retrospective Studies , Uveitis, Anterior/virology , Young AdultABSTRACT
INTRODUCTION: Cervical lymphadenitis is the most common nontuberculous mycobacteria (NTM) infection in immunocompetent children, mainly in those under 5years. For many years Mycobacterium lentiflavum (M. lentiflavum) has been considered a rare NTM causing lymphadenitis. METHODS: A restrospective study was performed in pediatric patients with microbiologically confirmed NTM cervical lympahdenitis at the Niño Jesús Hospital in Madrid during 2009-2016. RESULTS: During the period studied, 28 cases of cervical lymphadenitis were recorded. In 23 (82.14%) and in 5 (17,85%) cases, M. lentiflavum and Mycobacterium avium were isolated, respectively. In those patients infected with M. lentiflavum, the most frequent location was sub-maxilar (43.47%); 15 (65.21%) were boys, global median age was 30,8 months and all cases showed a satisfactory evolution. CONCLUSION: We propose that M. lentiflavum should be considered an important emergent pathogen cause of cervical lymphadenitis in the pediatric population.
Subject(s)
Lymphadenitis/microbiology , Mycobacterium Infections, Nontuberculous , Child, Preschool , Female , Humans , Infant , Lymphadenitis/diagnosis , Lymphadenitis/epidemiology , Lymphadenitis/therapy , Male , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/therapy , Neck , Retrospective StudiesABSTRACT
Introduction. Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is alack of evidence about patients attended in conventional units.Methods. A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units withsepsis were included and assigned to two cohorts according toSepsis Code (SC) activation (group A) or not (B). Baseline andevolution variables were collected.Results. A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed somefunctional disability. More bundles were completed in group A:blood cultures 95.2% vs 72.5% (p < 0.001), extended spectrumantibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation96.62% vs 80.95% (p < 0.001). Infection control at 72 hourswas quite higher in group A (81.42% vs 55.18%, odds ratio3.55 [2.48-5.09]). Antibiotic was optimized more frequently ingroup A (60.77% vs 47.03%, p 0.008). Mean in-hospital staywas 10.63 days (11.44 vs 8.53 days, p < 0.001). Complicationsduring hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs24.76%, p < 0.001). 28-day mortality was significantly lower ingroup A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]).Conclusions. Implementation of SC seems to be effectivein improving short-term outcomes in IM patients, althoughtherapy should be tailored in an individual basis (AU)
Introducción. La sepsis es la principal causa de muerte enlos hospitales y la implantación de códigos para su manejo hademostrado mejorar su evolución. Sin embargo, es escasa laevidencia relativa a los pacientes atendidos en unidades médicas convencionales.Métodos. Se realizó un estudio de cohortes retrospectivode 3 años. Se incluyeron pacientes con sepsis hospitalizados enunidades de Medicina Interna y se asignaron a dos cohortessegún la activación del Código Sepsis (CS) (grupo A) o no (B).Se recogieron variables basales y de evolución.Resultados. Se incluyeron 653 pacientes. En 296 casos seactivó el SC. La edad media fue de 81,43 años, la mediana delíndice de comorbilidad de Charlson (ICC) fue de 2 y el 63,25%presentaba alguna limitación funcional. Se realizaron más acciones diagnósticas y terapéuticas en el grupo A: hemocultivos95,2% vs 72,5% (p < 0,001), antibióticos de espectro extendido59,1% vs 41,4% (p < 0,001), reanimación con líquidos 96,62%vs 80,95% (p < 0,001). El control de la infección a las 72 horasfue superior en el grupo A (81,42% vs 55,18%, odds ratio 3,55[2,48-5,09]). La optimización de los antibióticos fue más frecuente en el grupo A (60,77% vs 47,03%, p 0,008). La estanciamedia en el hospital fue de 10,63 días (11,44 vs 8,53 días, p <0,001). Aparecieron complicaciones durante la hospitalizaciónen el 51,76% de los pacientes, especialmente en el grupo B(45,95% vs 56,58%, odds ratio 1,53 [1,12-2,09]). Los pacientesdel grupo A reingresaron más (40% vs 24,76%, p < 0,001). Lamortalidad a los 28 días fue significativamente menor en elgrupo A (20,95% frente a 42,86%, odds ratio 0,33 [0,23-0,47]). (AU)
Subject(s)
Humans , Aged , Aged, 80 and over , Sepsis , Hospitalization , Internal Medicine , Hospital Mortality , Retrospective Studies , Cohort StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Actinomyces , Actinomycosis/complications , Peritonsillar Abscess/microbiologyABSTRACT
INTRODUCCIÓN: La linfadenitis cervical es la infección más frecuente por micobacterias no tuberculosas (MNT) en niños inmunocompetentes, principalmente menores de 5 años. Durante años se ha considerado a Mycobacterium lentiflavum (M. lentiflavum) una inusual MNT causante de esta patología. MÉTODOS: Se realizó un estudio retrospectivo, observacional desde 2009 a 2016, que incluyó a pacientes pediátricos del Hospital Infantil Universitario Niño Jesús de Madrid, diagnosticados clínicamente y microbiológicamente de linfadenitis cervical por MNT. RESULTADOS: En el periodo estudiado se registraron 28 casos de linfadenitis cervical. En 23 (82,14%) pacientes se aisló M. lentiflavum y en 5 (17,85%), Mycobacterium avium. De los 23 pacientes con infección por M. lentiflavum, la localización más frecuente fue la submandibular (43,47%), 15 (65,21%) fueron niños, la media de edad global fue de 30,8 meses y todos los casos evolucionaron satisfactoriamente. CONCLUSIÓN: M. lentiflavum debe ser considerado como un importante patógeno emergente causante de linfadenitis cervical en población pediátrica
INTRODUCTION: Cervical lymphadenitis is the most common nontuberculous mycobacteria (NTM) infection in immunocompetent children, mainly in those under 5years. For many years Mycobacterium lentiflavum (M. lentiflavum) has been considered a rare NTM causing lymphadenitis. METHODS: A restrospective study was performed in pediatric patients with microbiologically confirmed NTM cervical lympahdenitis at the Niño Jesús Hospital in Madrid during 2009-2016. RESULTS: During the period studied, 28 cases of cervical lymphadenitis were recorded. In 23 (82.14%) and in 5 (17,85%) cases, M. lentiflavum and Mycobacterium avium were isolated, respectively. In those patients infected with M. lentiflavum, the most frequent location was sub-maxilar (43.47%); 15 (65.21%) were boys, global median age was 30,8 months and all cases showed a satisfactory evolution. CONCLUSION: We propose that M. lentiflavum should be considered an important emergent pathogen cause of cervical lymphadenitis in the pediatric population
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Tuberculosis, Lymph Node/microbiology , Tuberculosis, Lymph Node/diagnosis , Mycobacterium/classification , Mycobacterium/isolation & purification , Retrospective Studies , Biopsy, Fine-Needle , Observational StudyABSTRACT
No disponible