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1.
Euro Surveill ; 25(30)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32734857

RESUMO

We report a case of Legionella pneumonia in a dishwasher of a restaurant in Rome, Italy, just after the end of the lockdown that was in place to control the SARS-CoV-2 epidemic. The case highlights the importance of strict monitoring of water and air systems immediately before reopening business or public sector buildings, and the need to consider Legionella infections among the differential diagnosis of respiratory infections after lockdown due to the ongoing COVID-19 pandemic.


Assuntos
Antígenos de Bactérias/urina , Legionella pneumophila/isolamento & purificação , Legionella/isolamento & purificação , Doença dos Legionários/diagnóstico , Levofloxacino/uso terapêutico , Pneumonia/diagnóstico , Administração Intravenosa , Adulto , Anti-Infecciosos Urinários/uso terapêutico , Tosse/etiologia , Febre/etiologia , Cefaleia/etiologia , Humanos , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/urina , Masculino , Pneumonia/tratamento farmacológico , Pneumonia/urina , Resultado do Tratamento
2.
Ugeskr Laeger ; 182(29)2020 07 13.
Artigo em Dinamarquês | MEDLINE | ID: mdl-32734862

RESUMO

This is a case report of a 68-year-old female referred to the SARS-CoV-2 ward with one week of intermittent fever and three days of progressive loss of vision. Laboratory work-up revealed severe coagulopathy, thrombocytopenia and hyperleukocytosis. MRI showed multiple ischaemic cortical lesions. Acute treatment with all-trans retinoic acid and cytoreduction was started and coagulation parameters corrected. Patients referred to pandemic wards must undergo stringent examination and be referred for further evaluation irrespective of suspected severe acute respiratory syndrome coronavirus-2 infection.


Assuntos
Cegueira/virologia , Infecções por Coronavirus/diagnóstico , Febre/virologia , Leucemia Promielocítica Aguda/complicações , Pneumonia Viral/diagnóstico , Idoso , Betacoronavirus , Infecções por Coronavirus/complicações , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Pandemias , Pneumonia Viral/complicações , Tretinoína/uso terapêutico
3.
BMC Infect Dis ; 20(1): 517, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677909

RESUMO

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency of major international concern. Real-time RT-PCR assays are recommended for diagnosis of COVID-19. Here we report a rare case of COVID-19 with multiple negative results for PCR assays outside Wuhan, China. CASE PRESENTATION: A 32-year old male was admitted to our hospital because of 6 days of unexplained fever on January 29, 2020. He had come from Wuhan city 10 days before admission. Five days before admission, no abnormality was noted in laboratory test, chest radiography, and nasopharyngeal swab test for the SARS-CoV-2 nucleic acid. The patient was treated with ibuprofen for alleviating fever. On admission, chest computed tomography showed multiple ground-glass opacities in right lower lung field. COVID-19 was suspected. Three times of nasopharyngeal swab specimens were collected after admission. However, none of the specimens were positive. The patient was confirmed with COVID-19 after fifth SARS-CoV-2 nucleic acid test. He was treated with lopinavir/ritonavir, recombinant human interferon alfa-2b inhalation, methylprednisolone. After 18 days of treatment, he was discharged with improved symptoms, lung lesions and negative results of nasopharyngeal swab. CONCLUSION: This case reminds clinician that a patient with high clinical suspicion of COVID-19 but multiple negative RT-PCR result should not be taken out of isolation. A combination of patient's exposure history, clinical manifestations, laboratory tests, and typical imaging findings plays a vital role in making preliminary diagnosis and guide early isolation and treatment. Repeat swab tests are helpful in diagnosis for this kind of patients.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Resultados Negativos , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Adulto , Betacoronavirus/genética , China/epidemiologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Febre/etiologia , Febre/virologia , Hospitalização , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Quarentena , Radiografia , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Incerteza
4.
MMWR Morb Mortal Wkly Rep ; 69(28): 904-908, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32673296

RESUMO

Coronavirus disease 2019 (COVID-19) was first detected in the United States in January 2020 (1), and by mid-July, approximately 3.4 million cases had been reported in the United States (2). Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states. Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3). Among 164 symptomatic patients with known onset during January 14-April 4, 2020, a total of 158 (96%) reported fever, cough, or shortness of breath. Among 57 hospitalized adult patients (aged ≥18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients. Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines. To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Avaliação de Sintomas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/virologia , Dispneia/virologia , Feminino , Febre/virologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-32605097

RESUMO

The Coronavirus Disease 2019 (COVID-19) has spread on a global scale in an extremely short time, causing hundreds of thousands of deaths, and, at the same time, triggering extreme panic. Prevention in medicine is considered the best protection action for individuals in order to avoid infections. This study investigates whether Greek citizens (N = 3359) take the necessary precautions to prevent developing the COVID-19 disease, and it segments them based on homogenous behavior groups. Lastly, it provides communication techniques that should be implemented, targeting each citizen segment for a long-term COVID-19 free country. Data analysis revealed the extent of the applied precaution measures. The ones most applied by citizens were to avoid non-mandatory transportation, contact with individuals with respiratory symptoms, and individuals of high risk for severe illness (vulnerable groups). On the other hand, the least applied measures are daily checks of body temperature, monitoring for fever, cough, or dyspnea, use of a face mask when in public places, or when using public transportation. Additionally, cluster analysis revealed five groups of citizens based on self-reported behavior, namely, the Meticulous Proactive Citizens, the Self-isolated Citizens, the Cautious Citizens, the Occasionally Cautious Citizens, and the Unconcerned Citizens. Communication strategies targeting each segment are also discussed.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Comunicação em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Betacoronavirus , Temperatura Corporal , Análise por Conglomerados , Tosse , Dispneia , Feminino , Febre , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Adulto Jovem
6.
Am Surg ; 86(6): 572-576, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683964

RESUMO

A surgeon failed to heed his own misgivings on taking a family vacation cruise. Despite scrupulous hand-washing and antiseptic precautions with anything within reach, he contracts COVID-19. His anxiety increased as his condition became increasingly serious: uncontrollable dry coughing spells, spiking fevers, and his worst symptom, progressive dyspnea and chest pain. From what he knew about the disease, he feared admission to the intensive care unit, a step that portended a significantly worse prognosis. After a week-and-a-half of illness, misery, and fear, he began to improve: first, his fevers diminished, breathing came more easily, and coughing spells occurred less frequently, if still unpredictably. Now with his strength slowly returning, he contemplated returning to work but was frustrated when tests showed he was still shedding active virions. Under quarantine and with time to reflect, he cautions against complacency with regard to the infectiousness of COVID-19. His own denial led to the loss of his health and livelihood. At home but still separated from his wife and children in a basement bedroom, the bittersweet circumstances of his reunion with them is a reminder of the preciousness of life and love of family.


Assuntos
Infecções por Coronavirus/psicologia , Negação em Psicologia , Pneumonia Viral/psicologia , Cirurgiões/psicologia , Ansiedade , Betacoronavirus , Dor no Peito/virologia , Infecções por Coronavirus/complicações , Tosse/virologia , Dispneia/virologia , Família , Medo , Febre/virologia , Humanos , Pandemias , Isolamento de Pacientes , Pneumonia Viral/complicações
7.
Ir Med J ; 113(5): 78, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32603572

RESUMO

Introduction This case series describes the diagnosis of the first case of community transmission of SARS-CoV-2 in the Republic of Ireland. Cases Case 1: A 25 year old male presented with dyspnoea, cough and high fevers for 4 days. He was commenced on broad-spectrum antimicrobials and oxygen therapy. His respiratory function deteriorated in spite of these measures and he required mechanical ventilation. CT showed left upper lobe consolidation as well as multifocal ground-glass opacification. Case 2: A 43 year-old male presented with headache and was found incidentally to have pneumonia. He was recently diagnosed with pituitary apoplexy secondary to an adenoma with resultant pituitary insufficiency but MRI brain was stable. His respiratory function deteriorated in spite of antibiotics and he required mechanical ventilation. CT showed likely atypical infection with resultant ARDS. Outcome Both underwent nasopharyngeal RT-PCR testing for SARS-CoV-2. Patient 2 was positive. Patient 1 was extubated and made a good recovery. Patient 2 was transferred to another centre for ECMO therapy. He died 27 days after transfer. Conclusion Given the atypical presentations in generally otherwise young and healthy individuals, the decision was made outside of national guidance to perform testing for SARS-CoV-2. This diagnosis had far-reaching implications for the SARS-CoV-2 pandemic within Ireland.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/virologia , Dispneia/virologia , Evolução Fatal , Febre/etiologia , Humanos , Irlanda/epidemiologia , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tomografia Computadorizada por Raios X
8.
Epidemiol Infect ; 148: e132, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32611465

RESUMO

Hubei province in China has had the most confirmed coronavirus disease 2019 (COVID-19) cases and has reported sustained transmission of the disease. Although Lu'an city is adjacent to Hubei province, its community transmission was blocked at the early stage, and the impact of the epidemic was limited. Therefore, we summarised the overall characteristics of the entire epidemic course in Lu'an to help cities with a few imported cases better contain the epidemic. A total of 69 confirmed COVID-19 cases and 11 asymptomatic carriers were identified in Lu'an during the epidemic from 12 January to 21 February 2020. Fifty-two (65.0%) cases were male, and the median age was 40 years. On admission, 56.5% of cases had a fever as the initial symptom, and pneumonia was present in 89.9% of cases. The mean serial interval and the mean duration of hospitalisation were 6.5 days (95% CI: 4.8-8.2) and 18.2 days (95% CI: 16.8-19.5), respectively. A total of 16 clusters involving 60 cases (17 first-generation cases and 43 secondary cases) were reported during the epidemic. We observed that only 18.9% (7/37) index cases resulted in community transmission during the epidemic in Lu'an, indicating that the scale of the epidemic was limited to a low level in Lu'an city. An asymptomatic carrier caused the largest cluster, involving 13 cases. Spread of COVID-19 by asymptomatic carriers represents an enormous challenge for countries responding to the pandemic.


Assuntos
Portador Sadio/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Portador Sadio/epidemiologia , Portador Sadio/transmissão , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Análise por Conglomerados , Infecções por Coronavirus/transmissão , Feminino , Febre , Humanos , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Vigilância da População/métodos , Fatores de Tempo , Adulto Jovem
9.
Medicina (B Aires) ; 80 Suppl 3: 25-30, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658844

RESUMO

This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral/diagnóstico , Respiração Artificial , Insuficiência Respiratória/terapia , Idoso , Argentina/epidemiologia , Astenia/etiologia , Betacoronavirus , Coronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(28): e20829, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664077

RESUMO

INTRODUCTION: Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review. PATIENT CONCERN: A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120-150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess. DIAGNOSIS: The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration. INTERVENTIONS: The patient discontinued AAS and only reserved ciclosporin A for AA treatment. OUTCOMES: Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions. CONCLUSION: It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.


Assuntos
Adenoma de Células Hepáticas/induzido quimicamente , Anemia Aplástica/complicações , Neoplasias Hepáticas/patologia , Estanozolol/efeitos adversos , Congêneres da Testosterona/efeitos adversos , Dor Abdominal/etiologia , Adenoma de Células Hepáticas/patologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Anemia Aplástica/tratamento farmacológico , Biópsia por Agulha Fina/métodos , Ciclosporina/uso terapêutico , Erros de Diagnóstico , Feminino , Febre/etiologia , Humanos , Imunossupressores/uso terapêutico , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/etiologia , Estanozolol/uso terapêutico , Congêneres da Testosterona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
11.
Cochrane Database Syst Rev ; 7: CD013665, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32633856

RESUMO

BACKGROUND: Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or cough, and signs such as oxygen saturation or lung auscultation findings, are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19 disease, or select patients for further diagnostic testing. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19 disease or COVID-19 pneumonia. SEARCH METHODS: On 27 April 2020, we undertook electronic searches in the Cochrane COVID-19 Study Register and the University of Bern living search database, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with suspected COVID-19 disease, or if they recruited known cases with COVID-19 disease and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards including reverse transcription polymerase chain reaction (RT-PCR), clinical expertise, imaging, serology tests and World Health Organization (WHO) or other definitions of COVID-19. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the QUADAS-2 checklist. Analyses were descriptive, presenting sensitivity and specificity in paired forest plots, in ROC (receiver operating characteristic) space and in dumbbell plots. We did not attempt meta-analysis due to the small number of studies, heterogeneity across studies and the high risk of bias. MAIN RESULTS: We identified 16 studies including 7706 participants in total. Prevalence of COVID-19 disease varied from 5% to 38% with a median of 17%. There were no studies from primary care settings, although we did find seven studies in outpatient clinics (2172 participants), and four studies in the emergency department (1401 participants). We found data on 27 signs and symptoms, which fall into four different categories: systemic, respiratory, gastrointestinal and cardiovascular. No studies assessed combinations of different signs and symptoms and results were highly variable across studies. Most had very low sensitivity and high specificity; only six symptoms had a sensitivity of at least 50% in at least one study: cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache. Of these, fever, myalgia or arthralgia, fatigue, and headache could be considered red flags (defined as having a positive likelihood ratio of at least 5) for COVID-19 as their specificity was above 90%, meaning that they substantially increase the likelihood of COVID-19 disease when present. Seven studies carried a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional four studies, we were unable to assess the risk for selection bias. These factors make it very difficult to determine the diagnostic properties of these signs and symptoms from the included studies. We also had concerns about the applicability of these results, since most studies included participants who were already admitted to hospital or presenting to hospital settings. This makes these findings less applicable to people presenting to primary care, who may have less severe illness and a lower prevalence of COVID-19 disease. None of the studies included any data on children, and only one focused specifically on older adults. We hope that future updates of this review will be able to provide more information about the diagnostic properties of signs and symptoms in different settings and age groups. AUTHORS' CONCLUSIONS: The individual signs and symptoms included in this review appear to have very poor diagnostic properties, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19 disease, are urgently needed. Results from such studies could inform subsequent management decisions such as self-isolation or selecting patients for further diagnostic testing. We also need data on potentially more specific symptoms such as loss of sense of smell. Studies in older adults are especially important.


Assuntos
Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde , Avaliação de Sintomas , Artralgia/diagnóstico , Artralgia/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Fadiga/diagnóstico , Fadiga/etiologia , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Humanos , Mialgia/diagnóstico , Mialgia/etiologia , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Exame Físico , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Viés de Seleção , Avaliação de Sintomas/classificação , Avaliação de Sintomas/estatística & dados numéricos
12.
BMC Infect Dis ; 20(1): 549, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727456

RESUMO

BACKGROUND: We aimed to report the epidemiological and clinical characteristics of hospitalized patients with coronavirus disease-19 (COVID-19) in Zengdu District, Hubei Province, China. METHODS: Clinical data on COVID-19 inpatients in Zengdu Hospital from January 27 to March 11, 2020 were collected; this is a community hospital in an area surrounding Wuhan and supported by volunteer doctors. All hospitalized patients with COVID-19 were included in this study. The epidemiological findings, clinical features, laboratory findings, radiologic manifestations, and clinical outcomes of these patients were analyzed. The patients were followed up for clinical outcomes until March 22, 2020. Severe COVID-19 cases include severe and critical cases diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. Severe and critical COVID-19 cases were diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. RESULTS: All hospitalized COVID-19 patients, 276 (median age: 51.0 years), were enrolled, including 262 non-severe and 14 severe patients. The proportion of patients aged over 60 years was higher in the severe group (78.6%) than in the non-severe group (18.7%, p < 0.01). Approximately a quarter of the patients (24.6%) had at least one comorbidity, such as hypertension, diabetes, or cancer, and the proportion of patients with comorbidities was higher in the severe group (85.7%) than in the non-severe group (21.4%, p < 0.01). Common symptoms included fever (82.2% [227/276]) and cough (78.0% [218/276]). 38.4% (106/276) of the patients had a fever at the time of admission. Most patients (94.9% [204/276]) were cured and discharged; 3.6% (10/276) deteriorated to a critical condition and were transferred to another hospital. The median COVID-19 treatment duration and hospital stay were 14.0 and 18.0 days, respectively. CONCLUSIONS: Most of the COVID-19 patients in Zengdu had mild disease. Older patients with underlying diseases were at a higher risk of progression to severe disease. The length of hospital-stay and antiviral treatment duration for COVID-19 were slightly longer than those in Wuhan. This work will contribute toward an understanding of COVID-19 characteristics in the areas around the core COVID-19 outbreak region and serve as a reference for decision-making for epidemic prevention and control in similar areas.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tempo de Internação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Tosse/epidemiologia , Feminino , Febre/epidemiologia , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
JAMA Netw Open ; 3(7): e2014549, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32639570

RESUMO

Importance: The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS). Objective: To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS. Design, Setting, and Participants: This retrospective cohort study included 124 patients who required 911 EMS care for COVID-19 in King County, Washington, a large metropolitan region covering 2300 square miles with 2.2 million residents in urban, suburban, and rural areas, between February 1, 2020, and March 18, 2020. Exposures: COVID-19 was diagnosed by reverse transcription-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a median (interquartile range) of 5 (3-9) days after the EMS encounter. Main Outcomes and Measures: Prevalence of clinical characteristics, symptoms, examination signs, and EMS impression and care. Results: Of the 775 confirmed COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147 unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients (53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions, and 57 patients (46.0%) resided in a long-term care facility. Based on EMS evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or shortness of breath. Based on individual examination findings, fever, tachypnea, or hypoxia were only present in a limited portion of cases, as follows: 43 of 84 encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively. Advanced care was typically not required, although in 24 encounters (16.3%), patients received care associated with aerosol-generating procedures. As of June 1, 2020, mortality among the study cohort was 52.4% (65 patients). Conclusions and Relevance: The findings of this cohort study suggest that screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion, at least in the prehospital emergency setting. The findings have potential implications for early identification of COVID-19 and effective strategies to mitigate infectious risk during emergency care.


Assuntos
Infecções por Coronavirus/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Serviços Médicos de Emergência , Febre/epidemiologia , Hipóxia/epidemiologia , Múltiplas Afecções Crônicas/epidemiologia , Pneumonia Viral/epidemiologia , Taquipneia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Técnicas de Laboratório Clínico , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Terapia Respiratória , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Washington/epidemiologia
14.
Medicine (Baltimore) ; 99(29): e21334, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702930

RESUMO

RATIONALE: The outbreak of coronavirus disease 2019 (COVID-19) in 2019 has become a global pandemic. It is not known whether the disease is associated with a higher risk of infection in pregnant women or whether intrauterine vertical transmission can occur. We report 2 cases of pregnant women diagnosed with COVID-19. PATIENT CONCERNS: In all of Yichang city from January 20, 2020, to April 9, 2020, only 2 pregnant women, who were in the late stage of pregnancy, were diagnosed with COVID-19; one patient was admitted for fever with limb asthenia, and the other patient was admitted for abnormal chest computed tomography results. DIAGNOSES: Both pregnant women were diagnosed with COVID-19. INTERVENTIONS: After the medical staff prepared for isolation and protection, the 2 pregnant women quickly underwent cesarean sections. A series of tests, such as laboratory, imaging, and SARS-CoV-2 nucleic acid examinations, were performed on the 2 women with COVID-19 and their newborns. OUTCOMES: One of the 2 infected pregnant women had severe COVID-19, and the other had mild disease. Both babies were delivered by cesarean section. Both of the women with COVID-19 worsened 3 to 6 days after delivery. Chest computed tomography suggested that the lesions due to SARS-CoV-2 infection increased. These women began to exhibit fever or reduced blood oxygen saturation again. One of the 2 newborns was born prematurely, and the other was born at full term. Neither infant was infected with COVID-19, but both had increased prothrombin time and fibrinogen, lactate dehydrogenase, phosphocreatine kinase, and creatine kinase isoenzyme contents. LESSONS: SARS-CoV-2 infection was not found in the newborns born to the 2 pregnant women with COVID-19, but transient coagulation dysfunction and myocardial damage occurred in the 2 newborns. Effective management strategies for pregnant women with COVID-19 will help to control the outbreak of COVID-19 among pregnant women.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Adulto , Astenia/etiologia , Betacoronavirus/isolamento & purificação , Cesárea/métodos , China/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Surtos de Doenças/prevenção & controle , Feminino , Febre/etiologia , Humanos , Recém-Nascido/sangue , Recém-Nascido/metabolismo , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral/tratamento farmacológico , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
15.
AIDS Res Ther ; 17(1): 46, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703286

RESUMO

BACKGROUND: The COVID-19 has been a severe pandemic all around the world. Nowadays the patient with co-infection of HIV and SARS-CoV-2 was rarely reported. Here we reported a special case with HIV and SARS-CoV-2 co-infection, which showed a prolonged viral shedding duration. CASE PRESENTATION: The patient was infected with HIV 8 years ago through sexual transmission and had the normal CD4+T cell count. She was found SARS-CoV-2 positive using real-time Polymerase Chain Reaction (RT-PCR) during the epidemic. Most importantly, the patient had a prolonged viral shedding duration of SARS-CoV-2 about 28 days. CONCLUSION: The viral shedding duration may be prolonged in people living with HIV. The 14 days isolation strategy might not be long enough for them. The isolation or discharge of these patients needs further confirmation for preventing epidemics.


Assuntos
Antirretrovirais/uso terapêutico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por HIV/complicações , Pneumonia Viral/diagnóstico , Eliminação de Partículas Virais , Benzoxazinas/administração & dosagem , Betacoronavirus/genética , Betacoronavirus/imunologia , Proteína C-Reativa/análise , Contagem de Linfócito CD4 , Calafrios , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Fadiga , Feminino , Febre , HIV/crescimento & desenvolvimento , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Imunoglobulina M/sangue , Lamivudina/administração & dosagem , Pessoa de Meia-Idade , Pandemias , Faringite , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Reação em Cadeia da Polimerase em Tempo Real , Escarro/virologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Eliminação de Partículas Virais/imunologia , Zidovudina/administração & dosagem
16.
Mol Med Rep ; 22(3): 2583-2587, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32705222

RESUMO

Since December 2019, an increasing number of cases associated with the 2019 novel coronavirus (2019­nCoV) have emerged in Wuhan, China, which has resulted in a rapid outbreak in China and worldwide. The present study aimed to describe the clinical, laboratory and radiological characteristics of 2019­nCoV pneumonia (NCP) in Zhejiang province, outside of Wuhan. A total of 74 patients with 2019­nCoV were continuously enrolled between January 22 and March 2, 2020 at Zhejiang Hospital. Diagnosis was confirmed at Zhejiang Hospital by reverse transcription­PCR (RT­PCR), which was approved by the Chinese government. Subsequently, the clinical features between positive­ and negative­NCP patients in Zhejiang were compared. Among the 74 hospitalized patients with suspected 2019­NCP, six patients (one male and five female patients) were confirmed to be infected with 2019­nCoV by RT­PCR. The average age of the confirmed patients was 40±13 years. There were three family clusters among the confirmed cases, one patient from each of these families had travel history or contact with patients from Wuhan within 2 weeks. Compared with non­NCP patients, the most common symptoms at onset for patients with NCP were fever (5/6; 83.3%) and cough (5/6; 83.3%), followed by dyspnea/pharyngalgia (2/6; 33.3%), whereas myalgia (1/6; 16.7%) and fatigue (1/6; 16.7%) were less common. All 74 patients with suspected NCP exhibited abnormal computerized tomography (CT) images. In total, 2/6 (33.3%) patients with confirmed NCP presented with bilateral pneumonia, and 21/68 (30.9%) non­NCP patients exhibited bilateral pneumonia, with bilateral distribution of patchy shadows or ground glass opacity. The present study revealed that epidemiological history was critical to the diagnosis of 2019­nCoV in low epidemic regions outside Hubei province. It was also identified that chest CT could not replace nucleic acid testing due to similar radiological manifestations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Tosse/etiologia , Fadiga/etiologia , Febre/etiologia , Pneumonia Viral/complicações , Adulto , China/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Tosse/patologia , Fadiga/patologia , Feminino , Febre/patologia , Humanos , Incidência , Masculino , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
17.
Medicine (Baltimore) ; 99(29): e20900, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702831

RESUMO

Cerebral venous sinus thrombosis (CVST) is a cause of secondary headache with substantial morbimortality. Headache dominates the clinical presentation, but no typical phenotype has been described. We aim to evaluate the presence of red flags in headache in patients with confirmed CVST at the moment of emergency department (ED) presentation.Retrospective STROBE compliant cohort study including patients with confirmed CVST that consulted because of headache at the ED. We analyzed presence and type of red flags at the moment of consult. We evaluated whether CVST was suspected at the moment of imaging request and analyzed delay in the diagnosis.Nineteen patients fulfilled inclusion and exclusion criteria. Mean age was 48.5 years, 47.4% were female. All the studied patients exhibited at least 1 red flag, being abnormal neurological examination the most frequent (79%), followed by the presence of other neurological symptoms (68%), alarm data related with headache phenotype (63%), or risk factors concerning prior medical history (47%). Temporal pattern of the headache was acute in 42.1%, thunderclap in 31.6%, and subacute in 26.3%. In none patient CVST was the specific suspicion when imaging was requested. Median time since headache onset and ED presentation was 84 hours, being different in patients with associated symptoms (48 hours) when compared with isolated headache patients (168 hours). Time since ED presentation and the diagnosis also differed between the 2 groups, being more prolonged in patients with an isolated headache at presentation.Headache attributed with CVST did not exhibit any distinctive phenotype, but all the patients presented some red flag, being abnormal neurological examination the most frequent.


Assuntos
Cefaleia/etiologia , Trombose dos Seios Intracranianos/diagnóstico , Afasia/etiologia , Comportamento , Estudos de Coortes , Transtornos da Consciência/etiologia , Serviço Hospitalar de Emergência , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Paresia/etiologia , Estudos Retrospectivos , Medição de Risco , Convulsões/etiologia , Transtornos das Sensações/etiologia , Distúrbios da Fala/etiologia , Manobra de Valsalva
18.
Medicine (Baltimore) ; 99(29): e21115, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702861

RESUMO

INTRODUCTION: To report the clinical characteristics of primary central nervous system T-cell lymphoma with anaplastic lymphoma kinase-1 (ALK-1) positive in an 8-year-old male. PATIENT CONCERNS: The patient presented cognitive impairment, dizziness, vomiting, fever, and convulsions during the disease, followed by progressive and persistent severe headache, progressive increase of intracranial pressure, indifference, disorder of consciousness, mild increase in white blood cells in cerebrospinal fluid, progressive decrease of sugar, progressive increase of protein, abnormal signal of left parietal-occipital, local meningeal enhancement, and cerebrospinal fluid cytology. DIAGNOSIS: He was diagnosed with ALK-1-positive central nervous system T-cell lymphoma. INTERVENTIONS: Meropenem and vancomycin were administered to counter the infection, while dexamethasone alleviated the inflammation. OUTCOMES: The patient died of cerebral hernia due to intracranial hypertension in the eighth week of the disease. CONCLUSIONS: PCNS ALK-1-positive anaplastic large cell lymphoma is extremely rare. Also, it is difficult to distinguish from central meningeal lymphoma and central nervous system infection, which might lead to delayed diagnosis. However, early diagnosis depends on the pathological diagnosis of brain tissue biopsy.


Assuntos
Sistema Nervoso Central/anormalidades , Linfoma Anaplásico de Células Grandes/diagnóstico , Criança , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/mortalidade , Tontura/etiologia , Febre/etiologia , Cefaleia/etiologia , Humanos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/mortalidade , Imagem por Ressonância Magnética/métodos , Masculino , Convulsões/etiologia
19.
J Am Med Dir Assoc ; 21(7): 895-899.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32674815

RESUMO

OBJECTIVES: Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever, defined as a temperature of at least 38.0°C. The objective of this study was to describe the temperature changes before and after universal testing for SARS-CoV-2 in nursing home residents. DESIGN: Cohort study. SETTING AND PARTICIPANTS: The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment. MEASURES: All CLC residents (n = 7325) underwent SARS-CoV-2 testing. We report the temperature in the window of 14 days before and after universal SARS-CoV-2 testing among CLC residents. Baseline temperature was calculated for 5 days before the study window. RESULTS: SARS-CoV-2 was identified in 443 (6.0%) residents. The average maximum temperature in SARS-CoV-2-positive residents was 37.66 (0.69) compared with 37.11 (0.36) (P = .001) in SARS-CoV-2-negative residents. Temperatures in those with SARS-CoV-2 began rising 7 days before testing and remained elevated during the 14-day follow-up. Among SARS-CoV-2-positive residents, only 26.6% (n = 118) met the fever threshold of 38.0°C during the survey period. Most residents (62.5%, n = 277) with confirmed SARS-CoV-2 did experience 2 or more 0.5°C elevations above their baseline values. One cohort of SARS-CoV-2 residents' (20.3%, n = 90) temperatures never deviated >0.5°C from baseline. CONCLUSIONS AND IMPLICATIONS: A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered.


Assuntos
Infecções por Coronavirus/diagnóstico , Febre/diagnóstico , Programas de Rastreamento/métodos , Casas de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Idoso , Idoso de 80 Anos ou mais , Temperatura Corporal/fisiologia , Técnicas de Laboratório Clínico/métodos , Estudos de Coortes , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Diagnóstico Precoce , Feminino , Febre/epidemiologia , Humanos , Controle de Infecções , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Termômetros/estatística & dados numéricos , Estados Unidos , Veteranos
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