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1.
Acta Med Indones ; 52(3): 206-213, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020332

RESUMO

BACKGROUND: COVID-19 infection is caused by a novel coronavirus. One of the most used strategies that can be used to control the spread of COVID-19 is the 3T (test, trace, and treatment) strategy. This study aimed to evaluate the 3T strategy to control COVID-19 infection in a COVID-19 Referral Hospital in Depok, West Java, Indonesia. METHODS: this is a cross-sectional study conducted at the University of Indonesia Hospital. The study was conducted in June 2020 with 742 participants (staff members) using secondary data from polymerase chain reaction (PCR) test results. We presented data in the descriptive form and performed bivariate analysis using the chi-square/Fischer test for categorical data. RESULTS: the PCR test results were positive in 83 (11.1%) participants, with a case-per-tracing ratio of 1:24 and 1:2 in the first and third phases of tracing, respectively. The COVID-19 case graph for the participants decreased along with the implementation of the 3T strategy. The positivity rate in the first phase of tracing was 20% and decreased to 5% in the third phase of tracing. Staff with confirmed positive test results were advised to isolate themselves (hospital or self-isolation). Hospital isolation was found to be associated with the duration of PCR test conversion (p<0.001). CONCLUSION: the 3T strategy is effective for controlling the spread of COVID-19. The strategy should be implemented simultaneously with other health precautions to reduce the risk of spreading infection.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Transmissão de Doença Infecciosa/estatística & dados numéricos , Pandemias , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Humanos , Indonésia/epidemiologia , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estudos Retrospectivos
2.
Z Gastroenterol ; 58(9): 868-871, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32947632

RESUMO

BACKGROUND: Concurrent cytomegalovirus (CMV) in inflammatory bowel disease (IBD)-related colitis is an important scenario associated with high rates of colectomy and other morbidity. Due to the low incidence of CMV, testing of all patients is associated with an unacceptably high consumption of resources and delay in treatment. Therefore, several predictive scores have been developed to identify patients at risk for a CMV infection. METHODS: We performed a retrospective single center study in a German University hospital including all IBD patients with available data on CMV-PCR analysis in whole blood between 2010 and 2018 and evaluated 2 prognostic scores for CMV infection for their diagnostic accuracy. RESULTS: In the study, 907 patients with IBD and CMV-PCR were identified. Of them, 21 patients (2.3 %) had a positive CMV-PCR (≥ 1000 copies/mL), 14 of them in ulcerative colitis and 7 in Crohn's disease. The Berlin Score identified 667 patients (73.1 %) as potentially CMV-positive, resulting in a positive predictive value of 2.5 % and a negative predictive value of 98.3 %. In contrast, the Münster Score identified 60 patients as potentially CMV-positive, resulting in a PPV of 20 % and an NPV of 99.4 %. CONCLUSIONS: Scoring systems can help to identify patients at risk for a CMV infection and minimize resource consumption and delay in treatment. Due to low incidence, a 2-step-algorithm, consisting of the Münster Score followed by a CMV-PCR if the score indicates a CMV infection, is preferable.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/isolamento & purificação , Doenças Inflamatórias Intestinais/complicações , Infecções Oportunistas/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colite Ulcerativa , Citomegalovirus/genética , Infecções por Citomegalovirus/sangue , DNA Viral/análise , Feminino , Humanos , Doenças Inflamatórias Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/sangue , Infecções Oportunistas/patologia , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Nephrol Dial Transplant ; 35(8): 1338-1411, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871594

RESUMO

BACKGROUND: There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. METHODS: All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. RESULTS: Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66-83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0-5), 7 (4-11) and 32 (26.5-35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25-106) and 690 Ly/µL (IQR 450-960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11-3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005-1.017); P < 0.0001]. CONCLUSIONS: HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.


Assuntos
Betacoronavirus/genética , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/epidemiologia , DNA Viral/análise , Falência Renal Crônica/epidemiologia , Pneumonia Viral/epidemiologia , Diálise Renal/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Comorbidade , Infecções por Coronavirus/sangue , Feminino , França/epidemiologia , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pandemias , Pneumonia Viral/sangue , Estudos Prospectivos , Taxa de Sobrevida/tendências
4.
Medicine (Baltimore) ; 99(32): e21570, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769902

RESUMO

RATIONALE: Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction. PATIENT CONCERNS: We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DIAGNOSES: Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection. INTERVENTIONS: The patient was treated with empiric antibiotic and hydroxychloroquine. OUTCOMES: Clinical improvement ensued. At follow-up, the patient is well. LESSON: SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.


Assuntos
Ceftriaxona/administração & dosagem , Infecções por Coronavirus/diagnóstico , Hospitalização , Hidroxicloroquina/administração & dosagem , Síndrome de Ativação Macrofágica/diagnóstico , Pneumonia Viral/diagnóstico , Adolescente , Análise Química do Sangue , China , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/tratamento farmacológico , DNA Viral/análise , Diagnóstico Diferencial , Progressão da Doença , Quimioterapia Combinada , Eletrocardiografia/métodos , Seguimentos , Humanos , Síndrome de Ativação Macrofágica/terapia , Masculino , Pandemias , Alta do Paciente , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
Dan Med J ; 67(9)2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32800072

RESUMO

INTRODUCTION: As the coronavirus disease 2019 (COVID-19) epidemic evolves and test strategies change, understanding the concepts of testing (gold standard and test performance measures) becomes essential. The challenge of any novel disease is that the gold standard has yet to be defined. METHODS: We reanalysed published data on real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) of severe acute respiratory syndrome coronavirus-2 to illustrate how predictive values vary with disease prevalence, sensitivity (set to values between 30% and 95%) and specificity (set to 99% or 99.98%). We used published data on chest CT and RT-qPCR to examine the potential of latent class analysis to estimate the sensitivity and specificity of RT-qPCR when no single gold standard exists. RESULTS: For the various sensitivity values, the negative predictive value of a RT-qPCR test remained above 92% until a COVID-19 prevalence of > 10%. The positive predictive value (PPV) was more variable. For a sensitivity of 95% and a specificity of 99%, the PPV was less-than 10% at a prevalence of 0.1%, increasing to about 90% at a prevalence of 10%. This improved to a PPV of 85% and almost 100%, respectively, when specificity increased to 99.98%. In a restricted latent class analysis, the sensitivity was 97.1% and the specificity was 99.9%, which is similar to figures from the Danish Health Authority. However, derived predictive values depended on model specification. CONCLUSIONS: A high risk of false-positives should be considered when extending the testing strategy, whereas false-negatives may occur during local outbreaks. This may have consequences for, e.g., containment strategies and research. A confirmatory test (e.g., demonstrating seroconversion or repeated RT-qPCR) may be warranted. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Publicações Periódicas como Assunto , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Infecções por Coronavirus/virologia , Reações Falso-Negativas , Humanos , Pandemias , Pneumonia Viral/virologia
6.
Invest Ophthalmol Vis Sci ; 61(10): 29, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32797198

RESUMO

Purpose: This systematic review aimed to determine currently reported clinical and prodromal ocular symptoms in patients with coronavirus disease 2019 (COVID-19). Methods: An online article search was performed in PubMed and EMBASE. Altogether 15 studies (retrospective, prospective, or case studies) involving 1533 patients with COVID-19, reporting on ocular symptoms, and with outcome data available were identified. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Study-specific estimates (incidence rates of ocular symptoms in patients with COVID-19) of cases were combined using one-group meta-analysis in a random-effects model. Results: Of all included studies, 11.2% (95% confidence interval, 5.5-16.9; 78/1526 cases) reported ocular symptoms. The most common ocular finding was conjunctivitis. Prodromal ocular symptoms occurred in 12.5% (13/104 cases) of patients with COVID-19. Positive real-time polymerase chain reaction results were obtained for 16.7% (10/60 cases) of conjunctival samples and 0% (0/17 cases) of tear samples. Twelve ocular conjunctival swab samples tested positive for SARS-CoV-2. Ten cases were from subjects showing ocular symptoms (16.7%, 10/60 cases), and the remaining two cases were from subjects without ocular manifestation (1.8%, 2/113 cases). Limitations included the short study period, small sample size, findings were limited to the Asian population, only seven articles included ophthalmologic examination details, and there is currently no consensus on COVID-19 management. Conclusions: Ocular symptoms may occur in the presymptomatic phase as a prodromal symptom (12.5%, 13/104 cases), suggesting the possibility of viral transmission from the conjunctiva.


Assuntos
Conjuntivite Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Sintomas Prodrômicos , Síndrome Respiratória Aguda Grave/diagnóstico , Técnicas de Laboratório Clínico/métodos , Conjuntivite Viral/diagnóstico , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia
7.
J Hosp Med ; 15: 538-539, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32816669

RESUMO

Viral testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly early in the COVID-19 pandemic, was limited by supply of reagents. We pooled nasopharyngeal samples from patients at low risk of SARS-CoV-2 infection in groups of 3 for testing. Three weeks of testing using this strategy resulted in 530 patient tests in 179 cartridges; 4 positive test groups required the use of 11 additional cartridges with an overall positive rate of 0.8% in a low-risk population. This strategy resulted in the use of 340 fewer cartridges than if each test were performed on one patient sample. Pooled testing of low-risk populations allows for continued testing even when supplies are relatively scarce.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Testes Genéticos/métodos , Pacientes Internados , Pandemias , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
8.
Biosens Bioelectron ; 166: 112436, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32750677

RESUMO

Our recent experience of the COVID-19 pandemic has highlighted the importance of easy-to-use, quick, cheap, sensitive and selective detection of virus pathogens for the efficient monitoring and treatment of virus diseases. Early detection of viruses provides essential information about possible efficient and targeted treatments, prolongs the therapeutic window and hence reduces morbidity. Graphene is a lightweight, chemically stable and conductive material that can be successfully utilized for the detection of various virus strains. The sensitivity and selectivity of graphene can be enhanced by its functionalization or combination with other materials. Introducing suitable functional groups and/or counterparts in the hybrid structure enables tuning of the optical and electrical properties, which is particularly attractive for rapid and easy-to-use virus detection. In this review, we cover all the different types of graphene-based sensors available for virus detection, including, e.g., photoluminescence and colorimetric sensors, and surface plasmon resonance biosensors. Various strategies of electrochemical detection of viruses based on, e.g., DNA hybridization or antigen-antibody interactions, are also discussed. We summarize the current state-of-the-art applications of graphene-based systems for sensing a variety of viruses, e.g., SARS-CoV-2, influenza, dengue fever, hepatitis C virus, HIV, rotavirus and Zika virus. General principles, mechanisms of action, advantages and drawbacks are presented to provide useful information for the further development and construction of advanced virus biosensors. We highlight that the unique and tunable physicochemical properties of graphene-based nanomaterials make them ideal candidates for engineering and miniaturization of biosensors.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas Biossensoriais , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Grafite , Pneumonia Viral/diagnóstico , Vírus/isolamento & purificação , Reações Antígeno-Anticorpo , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Técnicas Biossensoriais/instrumentação , Técnicas Biossensoriais/métodos , Técnicas Biossensoriais/tendências , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Colorimetria , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , DNA Viral/análise , DNA Viral/genética , Técnicas Eletroquímicas , Desenho de Equipamento , Grafite/química , Humanos , Luminescência , Nanoestruturas/química , Hibridização de Ácido Nucleico , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Pontos Quânticos/química , Análise Espectral Raman , Ressonância de Plasmônio de Superfície , Virologia/métodos , Vírus/genética , Vírus/patogenicidade
9.
Am J Case Rep ; 21: e925786, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32694498

RESUMO

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the viral pathogen responsible for coronavirus disease 2019 (COVID-19), a pandemic respiratory illness. While many patients experience mild to moderate symptoms, severely affected patients often progress to acute respiratory distress syndrome (ARDS). Specific to COVID-19, abnormal coagulability appears to be a principal instigator in the progression of disease severity and mortality. In this report we summarize a case of COVID-19 in which extreme thrombophilia led to patient demise. CASE REPORT A 67-year-old man in New York presented to the hospital 14 days after testing positive for SARS-CoV-2 at an outpatient site. His initial presenting symptoms included sore throat, headache, fever, and diarrhea. He was brought in by his wife after developing sudden onset confusion and dysarthria. The patient's clinical picture, which was unstable on presentation, further deteriorated to involve significant desaturations, generalized seizure activity, and cardiac arrest requiring resuscitation. Upon return to spontaneous circulation, the patient required intensive care unit admission, mechanical ventilation, and vasopressor increases. Comprehensive workup uncovered coagulopathy with multiple thrombotic events involving the brain and lungs as well as radiographic evidence of severe lung disease. In the face of an unfavorable clinical picture, the family opted for comfort care measures. CONCLUSIONS In this case report on a 67-year-old-man with COVID-19, we present an account of extreme hypercoagulability that led to multiple thrombotic events eventually resulting in the man's demise. Abnormal coagulation 14 days from positive testing raises the question of whether outpatients with COVID-19 should be screened for hypercoagulability and treated with prophylactic anticoagulation/antiplatelet agents.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/complicações , DNA Viral/análise , Pneumonia Viral/complicações , Trombose/etiologia , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Trombose/diagnóstico
10.
Am J Dermatopathol ; 42(8): 564-570, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32701690

RESUMO

Skin manifestations of COVID-19 infections are diverse and are new to the dermatology community. We had the opportunity to examine the clinical and histopathological features of several patients who were divided into 3 groups. The first group included 8 COVID-19-positive patients who were hospitalized and quarantined at home. The second group included children and young adults who presented with chilblain erythema, erythema multiforme, and urticaria-like lesions. This group of patients was negative for the COVID-19 gene sequences by polymerase chain reaction but had a high risk of COVID-19 infection. The third group included clinically heterogeneous and challenging lesions. These patients were not subject to either polymerase chain reaction tests or serological analyses because they sought dermatological attention only for a dermatosis. The histopathological analysis of these cases showed a wide spectrum of histopathological patterns. What appears to be constant in all skin biopsies was the presence of prominent dilated blood vessels with a swollen endothelial layer, vessels engulfed with red blood cells, and perivascular infiltrates, consisting mainly of cytotoxic CD8+ lymphocytes and eosinophils. In 2 cases, there was diffuse coagulopathy in the cutaneous vascular plexus. In the early phases of the disease, there were numerous collections of Langerhans cells in the epidermis after being activated by the virus. The presence of urticarial lesions, chilblains, targetoid lesions (erythema multiforme-like lesions), exanthema, maculohemorrhagic rash, or chickenpox-like lesions associated with the histopathological features mentioned previously should cause clinical dermatologists to suspect the possibility of COVID-19 infection, especially in patients with fever and cough.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Dermatopatias Virais/epidemiologia , Dermatopatias Virais/patologia , Adolescente , Fatores Etários , Biópsia por Agulha , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , DNA Viral/análise , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Incidência , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase/métodos , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Índice de Gravidade de Doença , Fatores Sexuais , Dermatopatias Virais/terapia , Adulto Jovem
11.
Nat Commun ; 11(1): 3279, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32606306

RESUMO

Recombinant adeno-associated viruses (rAAVs) are currently considered the safest and most reliable gene delivery vehicles for human gene therapy. Three serotype capsids, AAV1, AAV2, and AAV9, have been approved for commercial use in patients, but they may not be suitable for all therapeutic contexts. Here, we describe a novel capsid identified in a human clinical sample by high-throughput, long-read sequencing. The capsid, which we have named AAVv66, shares high sequence similarity with AAV2. We demonstrate that compared to AAV2, AAVv66 exhibits enhanced production yields, virion stability, and CNS transduction. Unique structural properties of AAVv66 visualized by cryo-EM at 2.5-Å resolution, suggest that critical residues at the three-fold protrusion and at the interface of the five-fold axis of symmetry likely contribute to the beneficial characteristics of AAVv66. Our findings underscore the potential of AAVv66 as a gene therapy vector.


Assuntos
Proteínas do Capsídeo/genética , Capsídeo/metabolismo , Dependovirus/genética , Vetores Genéticos/genética , Animais , Capsídeo/ultraestrutura , Proteínas do Capsídeo/classificação , Sistema Nervoso Central/virologia , Microscopia Crioeletrônica , DNA Viral/análise , DNA Viral/genética , Dependovirus/classificação , Dependovirus/fisiologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Filogenia , Sorogrupo , Transdução Genética , Montagem de Vírus/genética
13.
Artigo em Inglês | MEDLINE | ID: mdl-32665398

RESUMO

OBJECTIVE: Severe liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19. DESIGN: We investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness. RESULTS: 12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death. CONCLUSION: Transient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/complicações , Técnicas de Imagem por Elasticidade/métodos , Hepatopatias/diagnóstico , Fígado/diagnóstico por imagem , Pneumonia Viral/complicações , Idoso , Biópsia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , DNA Viral/análise , Feminino , Humanos , Hepatopatias/etiologia , Testes de Função Hepática , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
14.
Diagn Microbiol Infect Dis ; 98(2): 115123, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32673978

RESUMO

Here, we retrospectively analyzed the comparative results of 182 paired dry nasopharyngeal swabs tested by Abbott ID NOW and nasopharyngeal swabs in viral transport medium by real-time RT-PCR methods. While the overall agreement was 96.2%, we found that of 15 samples that were tested positive with RT-PCR methods, 7 were missed by ID NOW, resulting in a false-negative rate of 47%.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Nasofaringe/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Centros Médicos Acadêmicos/organização & administração , Serviços de Laboratório Clínico/organização & administração , DNA Viral/análise , Bases de Dados Factuais , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pandemias , Estudos Retrospectivos , Amostragem , Sensibilidade e Especificidade , Manejo de Espécimes , Estados Unidos
15.
Diagn Microbiol Infect Dis ; 98(2): 115113, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682217

RESUMO

On 1 June 2020, 6 million cases of COVID-19 were recorded with a total of 374,927 deaths worldwide. Brazil, at that point, presented a total of 514,992 cases and 29,341 deaths caused by the COVID-19 disease. At that moment, Brazil appeared in the second position regarding number of cases, fourth in number of deaths, second in number of recovered patients (N = 206,555), second in number of follow-up cases (N = 279,096), third in number of active and serious cases (N = 8,318), 39th in number of cases per million inhabitants (N = 2,424), and 125th in number of SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) exams per million inhabitants (N = 4,378). To beat the pandemic, Brazil needs to optimize the COVID-19 diagnosis through the SARS-CoV-2 identification using RT-PCR tests and adjust its policies to save lives. Brazil is in a crucial moment to minimize the impact of the illness on society by reducing the number of new cases and thus, preventing deaths, mainly of the risk group populations. However, as widely announced, in Brazil the diagnosis using RT-PCR is still scarce and part of the material collected from COVID-19 patients was disposed of and many patients were not tested, regardless of the seriousness of the symptoms, due to errors of medical data records, improper conservation of the samples after collection and/or during transport, which compromised the quality of the material to be tested. Moreover, the federal government has supported the end of the quarantine, while the number of deaths has grown in thousands every day and the cases have been expanding to the interior of the country.


Assuntos
Causas de Morte , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Brasil/epidemiologia , DNA Viral/análise , Feminino , Saúde Global , Humanos , Masculino , Pandemias/estatística & dados numéricos , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sobrevida
16.
J Am Med Dir Assoc ; 21(7): 933-936, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674822

RESUMO

OBJECTIVE: To assess the American Testing Guidance for Nursing Homes (NHs)-updated May 19, 2020-with a new COVID-19 case. DESIGN: Case investigation. SETTING AND SUBJECTS: All 79 residents and 34 health care personnel (HCP) of an NH. METHODS: Seven days after identification of a COVID-19 resident, all residents and HCP underwent real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases, and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for enzyme-linked immunosorbent assay-based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP. RESULTS: A total of 36 residents had a positive rRT-PCR at baseline and 2 at day 7. Six HCP had a positive rRT-PCR at baseline and 2 at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2-positive cases, 6 residents (16%) and 3 HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive rRT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%), respectively, developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing. CONCLUSIONS AND IMPLICATIONS: This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative rRT-PCR testing can develop antibodies against SARS-CoV-2.


Assuntos
Técnicas de Laboratório Clínico/métodos , Busca de Comunicante/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Casas de Saúde/organização & administração , Anticorpos Antivirais/análise , Técnicas de Laboratório Clínico/estatística & dados numéricos , Busca de Comunicante/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , DNA Viral/análise , Feminino , Humanos , Masculino , Saúde do Trabalhador/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Estados Unidos/epidemiologia
18.
PLoS One ; 15(6): e0232610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497137

RESUMO

Pneumonia is one of the most important causes of morbidity and mortality in children. Identification and characterization of pathogens that cause infections are crucial for accurate treatment and accelerated recovery. However, in most cases, the causative agent cannot be identified, which is partly due to the limited spectrum of pathogens covered by current diagnostics based on nucleic acid amplification. Therefore, in this study, we explored the application of metagenomic next-generation sequencing (mNGS) for the diagnosis of children with severe pneumonia. From April to July 2017, 32 hospitalized children with severe nonresponding pneumonia in Shenzhen Children's Hospital were included in this study. Blood tests were conducted immediately after hospitalization to assess cell counts and inflammatory markers, oropharyngeal swabs were collected to identify common pathogens by qPCR and culture. After bronchoscopy, bronchoalveolar lavage fluid (BALF) samples were collected for further pathogen identification using standardized diagnostic tests and mNGS. Blood tests were normal in 3 of the 32 children. In 9 oropharyngeal swabs, bacterial pathogens were detected, in 5 of these Mycoplasma pneumoniae was detected. Adenovirus was detected in 5 BALF samples, using the Direct Immunofluorescence Assay (DFA). In 15 cases, no common pathogens were found in BALF samples, using the current standard diagnostic tests, while in all 32 BALFs, pathogens were identified using mNGS, including adenovirus, Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, cytomegalovirus and bocavirus. This study shows that, with mNGS, the sensitivity of detection of the causative pathogens in children with severe nonresponding pneumonia is significantly improved. In addition, mNGS gives more strain specific information, helps to identify new pathogens and could potentially help to trace and control outbreaks. In this study, we have shown that it is possible to have the results within 24 hours, making the application of mNGS feasible for clinical diagnostics.


Assuntos
Coinfecção , Metagenômica/métodos , Pneumonia Bacteriana/diagnóstico , Pneumonia Viral/diagnóstico , Contagem de Células Sanguíneas , Líquido da Lavagem Broncoalveolar/microbiologia , Líquido da Lavagem Broncoalveolar/virologia , Criança , Pré-Escolar , China/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , DNA Bacteriano/análise , DNA Viral/análise , Feminino , Técnica Direta de Fluorescência para Anticorpo , Humanos , Lactente , Pacientes Internados , Masculino , Metagenoma , Orofaringe/microbiologia , Orofaringe/virologia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudo de Prova de Conceito , RNA Viral/análise , Sensibilidade e Especificidade , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
20.
Clin Biochem ; 84: 73-78, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32592724

RESUMO

OBJECTIVES: A novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) emerged in late 2019, causing an outbreak of pneumonia [coronavirus disease 2019 (COVID-19)] globally. Although the use of ready-made reaction mixes can enable more rapid PCR-based diagnosis of COVID-19, the need to transport and store these mixes at low temperatures presents challenges to already overburdened logistics networks. METHODS: Here, we present an optimized freeze-drying procedure that allows SARS-CoV-2 PCR mixes to be transported and stored at ambient temperatures, without loss of activity. Additive-supplemented PCR mixes were freeze-dried. The residual moisture of the freeze-dried PCR mixes was measured by Karl-Fischer titration. RESULTS: We found that the freeze-dried PCR mixes with ~1.2% residual moisture are optimal for storage, transport, and reconstitution. The sensitivity, specificity, and repeatability of the freeze-dried reagents were similar to those of freshly prepared, wet reagents. The freeze-dried mixes retained activity at room temperature (18 ~ 25 °C) for 28 days, and for 14 and 10 days when stored at 37 °C and 56 °C, respectively. CONCLUSION: The uptake of this approach will ease logistical challenges faced by transport networks and make more cold storage space available at diagnosis and hospital laboratories.


Assuntos
Betacoronavirus/genética , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Primers do DNA/química , DNA Viral/análise , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , DNA Viral/genética , Liofilização , Humanos , Pandemias , Pneumonia Viral/virologia , Temperatura
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