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Fenrich M, Mrdenovic S, Balog M, Tomic S, Zjalic M, Roncevic A, Mandic D, Debeljak Z, Heffer M. SARS-CoV-2 Dissemination Through Peripheral Nerves Explains Multiple Organ Injury. Front Cell Neurosci 2020; 14:229. [PMID: 32848621 PMCID: PMC7419602 DOI: 10.3389/fncel.2020.00229] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease (CoVID-19), caused by recently identified severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), is characterized by inconsistent clinical presentations. While many infected individuals remain asymptomatic or show mild respiratory symptoms, others develop severe pneumonia or even respiratory distress syndrome. SARS-CoV-2 is reported to be able to infect the lungs, the intestines, blood vessels, the bile ducts, the conjunctiva, macrophages, T lymphocytes, the heart, liver, kidneys, and brain. More than a third of cases displayed neurological involvement, and many severely ill patients developed multiple organ infection and injury. However, less than 1% of patients had a detectable level of SARS-CoV-2 in the blood, raising a question of how the virus spreads throughout the body. We propose that nerve terminals in the orofacial mucosa, eyes, and olfactory neuroepithelium act as entry points for the brain invasion, allowing SARS-CoV-2 to infect the brainstem. By exploiting the subcellular membrane compartments of infected cells, a feature common to all coronaviruses, SARS-CoV-2 is capable to disseminate from the brain to periphery via vesicular axonal transport and passive diffusion through axonal endoplasmic reticula, causing multiple organ injury independently of an underlying respiratory infection. The proposed model clarifies a wide range of clinically observed phenomena in CoVID-19 patients, such as neurological symptoms unassociated with lung pathology, protracted presence of the virus in samples obtained from recovered patients, exaggerated immune response, and multiple organ failure in severe cases with variable course and dynamics of the disease. We believe that this model can provide novel insights into CoVID-19 and its long-term sequelae, and establish a framework for further research.
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Affiliation(s)
- Matija Fenrich
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Stefan Mrdenovic
- Department of Hematology, Clinic of Internal Medicine, University Hospital Osijek, Osijek, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marta Balog
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Svetlana Tomic
- Clinic of Neurology, University Hospital Osijek, Osijek, Croatia
- Department of Neurology and Neurosurgery, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Milorad Zjalic
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Alen Roncevic
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dario Mandic
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Clinical Institute of Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
| | - Zeljko Debeljak
- Clinical Institute of Laboratory Diagnostics, University Hospital Osijek, Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marija Heffer
- Laboratory of Neurobiology, Department of Medical Biology and Genetics, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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402
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Feng W, Newbigging AM, Le C, Pang B, Peng H, Cao Y, Wu J, Abbas G, Song J, Wang DB, Cui M, Tao J, Tyrrell DL, Zhang XE, Zhang H, Le XC. Molecular Diagnosis of COVID-19: Challenges and Research Needs. Anal Chem 2020; 92:10196-10209. [PMID: 32573207 PMCID: PMC7346719 DOI: 10.1021/acs.analchem.0c02060] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
Molecular diagnosis of COVID-19 primarily relies on the detection of RNA of the SARS-CoV-2 virus, the causative infectious agent of the pandemic. Reverse transcription polymerase chain reaction (RT-PCR) enables sensitive detection of specific sequences of genes that encode the RNA dependent RNA polymerase (RdRP), nucleocapsid (N), envelope (E), and spike (S) proteins of the virus. Although RT-PCR tests have been widely used and many alternative assays have been developed, the current testing capacity and availability cannot meet the unprecedented global demands for rapid, reliable, and widely accessible molecular diagnosis. Challenges remain throughout the entire analytical process, from the collection and treatment of specimens to the amplification and detection of viral RNA and the validation of clinical sensitivity and specificity. We highlight the main issues surrounding molecular diagnosis of COVID-19, including false negatives from the detection of viral RNA, temporal variations of viral loads, selection and treatment of specimens, and limiting factors in detecting viral proteins. We discuss critical research needs, such as improvements in RT-PCR, development of alternative nucleic acid amplification techniques, incorporating CRISPR technology for point-of-care (POC) applications, validation of POC tests, and sequencing of viral RNA and its mutations. Improved assays are also needed for environmental surveillance or wastewater-based epidemiology, which gauges infection on the community level through analyses of viral components in the community's wastewater. Public health surveillance benefits from large-scale analyses of antibodies in serum, although the current serological tests do not quantify neutralizing antibodies. Further advances in analytical technology and research through multidisciplinary collaboration will contribute to the development of mitigation strategies, therapeutics, and vaccines. Lessons learned from molecular diagnosis of COVID-19 are valuable for better preparedness in response to other infectious diseases.
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Affiliation(s)
- Wei Feng
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - Ashley M. Newbigging
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - Connie Le
- Li Ka Shing Institute of Virology, Department of
Medical Microbiology and Immunology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2E1
| | - Bo Pang
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - Hanyong Peng
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - Yiren Cao
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - Jinjun Wu
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - Ghulam Abbas
- National Laboratory of Biomacromolecules, Institute of
Biophysics, Chinese Academy of Sciences, No. 15 Datun Road,
Beijing, China 100101
| | - Jin Song
- National Laboratory of Biomacromolecules, Institute of
Biophysics, Chinese Academy of Sciences, No. 15 Datun Road,
Beijing, China 100101
| | - Dian-Bing Wang
- National Laboratory of Biomacromolecules, Institute of
Biophysics, Chinese Academy of Sciences, No. 15 Datun Road,
Beijing, China 100101
| | - Mengmeng Cui
- National Laboratory of Biomacromolecules, Institute of
Biophysics, Chinese Academy of Sciences, No. 15 Datun Road,
Beijing, China 100101
| | - Jeffrey Tao
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - D. Lorne Tyrrell
- Li Ka Shing Institute of Virology, Department of
Medical Microbiology and Immunology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2E1
| | - Xian-En Zhang
- National Laboratory of Biomacromolecules, Institute of
Biophysics, Chinese Academy of Sciences, No. 15 Datun Road,
Beijing, China 100101
| | - Hongquan Zhang
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
| | - X. Chris Le
- Division of Analytical and Environmental Toxicology,
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta,
Canada T6G 2G3
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403
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Gand M, Vanneste K, Thomas I, Van Gucht S, Capron A, Herman P, Roosens NHC, De Keersmaecker SCJ. Use of Whole Genome Sequencing Data for a First in Silico Specificity Evaluation of the RT-qPCR Assays Used for SARS-CoV-2 Detection. Int J Mol Sci 2020; 21:E5585. [PMID: 32759818 PMCID: PMC7432934 DOI: 10.3390/ijms21155585] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/26/2022] Open
Abstract
The current COronaVIrus Disease 2019 (COVID-19) pandemic started in December 2019. COVID-19 cases are confirmed by the detection of SARS-CoV-2 RNA in biological samples by RT-qPCR. However, limited numbers of SARS-CoV-2 genomes were available when the first RT-qPCR methods were developed in January 2020 for initial in silico specificity evaluation and to verify whether the targeted loci are highly conserved. Now that more whole genome data have become available, we used the bioinformatics tool SCREENED and a total of 4755 publicly available SARS-CoV-2 genomes, downloaded at two different time points, to evaluate the specificity of 12 RT-qPCR tests (consisting of a total of 30 primers and probe sets) used for SARS-CoV-2 detection and the impact of the virus' genetic evolution on four of them. The exclusivity of these methods was also assessed using the human reference genome and 2624 closely related other respiratory viral genomes. The specificity of the assays was generally good and stable over time. An exception is the first method developed by the China Center for Disease Control and prevention (CDC), which exhibits three primer mismatches present in 358 SARS-CoV-2 genomes sequenced mainly in Europe from February 2020 onwards. The best results were obtained for the assay of Chan et al. (2020) targeting the gene coding for the spiking protein (S). This demonstrates that our user-friendly strategy can be used for a first in silico specificity evaluation of future RT-qPCR tests, as well as verifying that the former methods are still capable of detecting circulating SARS-CoV-2 variants.
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Affiliation(s)
- Mathieu Gand
- Transversal activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium; (M.G.); (K.V.); (N.H.C.R.)
| | - Kevin Vanneste
- Transversal activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium; (M.G.); (K.V.); (N.H.C.R.)
| | - Isabelle Thomas
- Viral Diseases, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium; (I.T.); (S.V.G.)
| | - Steven Van Gucht
- Viral Diseases, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium; (I.T.); (S.V.G.)
| | - Arnaud Capron
- Quality of Laboratories, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium;
| | - Philippe Herman
- Expertise and Service Provision, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium;
| | - Nancy H. C. Roosens
- Transversal activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium; (M.G.); (K.V.); (N.H.C.R.)
| | - Sigrid C. J. De Keersmaecker
- Transversal activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, B-1050 Brussels, Belgium; (M.G.); (K.V.); (N.H.C.R.)
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404
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Martinez RM. Clinical Samples for SARS-CoV-2 Detection: Review of the Early Literature. CLINICAL MICROBIOLOGY NEWSLETTER 2020; 42:121-127. [PMID: 32834295 PMCID: PMC7377694 DOI: 10.1016/j.clinmicnews.2020.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In January 2020, a cluster of pneumonia cases was reported in Wuhan, China. A global pandemic followed. The infection, called novel coronavirus disease 2019 (COVID-19), is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Common symptoms of COVID-19 illness included fever, cough, and abnormal findings on chest computed tomography. Nucleic acid testing, in the form of real-time reverse transcriptase polymerase chain reaction, is essential for diagnosing COVID-19 from respiratory samples from infected patients. Still, many questions remain surrounding the optimization of pre-analytical factors, such as specimen selection, collection, and transport. This review summarizes the current publications that describe viral density and specimen suitability for molecular detection methods. Of note, many of the reports represent studies with small sample sizes, and information may change as more is learned about specimen types as the pandemic continues.
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405
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Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, Najafian B, Deutsch G, Lacy JM, Williams T, Yarid N, Marshall DA. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. Lancet 2020; 396:320-332. [PMID: 32682491 PMCID: PMC7365650 DOI: 10.1016/s0140-6736(20)31305-2] [Citation(s) in RCA: 576] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism. METHODS In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR. FINDINGS The median age of our cohort was 73·5 years (range 42-84; IQR 67·5-77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue. INTERPRETATION The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. FUNDING None.
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Affiliation(s)
- Benjamin T Bradley
- Department of Pathology, University of Washington, Seattle, WA, USA; Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
| | - Heather Maioli
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | | | - Susan L Fink
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Haodong Xu
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Behzad Najafian
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Gail Deutsch
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - J Matthew Lacy
- Snohomish County Medical Examiner's Office, Everett, WA, USA
| | | | - Nicole Yarid
- King County Medical Examiner's Office, Seattle, WA, USA
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406
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Carpenter CR, Mudd PA, West CP, Wilber E, Wilber ST. Diagnosing COVID-19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases. Acad Emerg Med 2020; 27:653-670. [PMID: 32542934 PMCID: PMC7323136 DOI: 10.1111/acem.14048] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.
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Affiliation(s)
- Christopher R. Carpenter
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MO USA
| | - Philip A. Mudd
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MO USA
| | - Colin P. West
- the Division of General Internal Medicine Department of Medicine Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
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407
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Chadi SA, Guidolin K, Caycedo-Marulanda A, Sharkawy A, Spinelli A, Quereshy FA, Okrainec A. Current Evidence for Minimally Invasive Surgery During the COVID-19 Pandemic and Risk Mitigation Strategies: A Narrative Review. Ann Surg 2020; 272:e118-e124. [PMID: 32675513 PMCID: PMC7268822 DOI: 10.1097/sla.0000000000004010] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our objective was to review the literature surrounding the risks of viral transmission during laparoscopic surgery and propose mitigation measures to address these risks. SUMMARY BACKGROUND DATA The SARS-CoV-2 pandemic has caused surgeons the world over to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. International society guidelines advise against the use of laparoscopy; however, the evidence on this topic is scant and recommendations are based on the perceived most cautious course of action. METHODS We conducted a narrative review of the existing literature surrounding the risks of viral transmission during laparoscopic surgery and balance these risks against the benefits of minimally invasive approaches. We also propose mitigation measures to address these risks that we have adopted in our institution. RESULTS AND CONCLUSION While it is currently assumed that open surgery minimizes operating room staff exposure to the virus, our findings reveal that this may not be the case. A well-informed, evidence-based opinion is critical when making decisions regarding which operative approach to pursue, for the safety and well-being of the patient, the operating room staff, and the healthcare system at large. Minimally invasive surgical approaches offer significant advantages with respect to both patient care, and the mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present.
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Affiliation(s)
- Sami A Chadi
- Department of Surgery, Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada
| | - Keegan Guidolin
- Department of Surgery, Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | | | - Abdu Sharkawy
- Department of Medicine, Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Fayez A Quereshy
- Department of Surgery, Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada
| | - Allan Okrainec
- Department of Surgery, Faculty of Medicine, University of Toronto and University Health Network, Toronto, Canada
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408
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Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, Najafian B, Deutsch G, Lacy JM, Williams T, Yarid N, Marshall DA. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. Lancet 2020. [PMID: 32682491 DOI: 10.1016/s0140-6736(2031305-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism. METHODS In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR. FINDINGS The median age of our cohort was 73·5 years (range 42-84; IQR 67·5-77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue. INTERPRETATION The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. FUNDING None.
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Affiliation(s)
- Benjamin T Bradley
- Department of Pathology, University of Washington, Seattle, WA, USA; Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
| | - Heather Maioli
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | | | - Susan L Fink
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Haodong Xu
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Behzad Najafian
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Gail Deutsch
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - J Matthew Lacy
- Snohomish County Medical Examiner's Office, Everett, WA, USA
| | | | - Nicole Yarid
- King County Medical Examiner's Office, Seattle, WA, USA
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409
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Goker Bagca B, Biray Avci C. The potential of JAK/STAT pathway inhibition by ruxolitinib in the treatment of COVID-19. Cytokine Growth Factor Rev 2020; 54:51-62. [PMID: 32636055 PMCID: PMC7305753 DOI: 10.1016/j.cytogfr.2020.06.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/11/2023]
Abstract
Ruxolitinib is the first approved JAK1 and JAK2 inhibitor, and is known to interfere with the JAK / STAT signaling pathway, one of the critical cellular signaling pathways involved in the inflammatory response. This review presents an overview of SARS-CoV-2 and the COVID-19 pandemic, and then focuses on the potential efficacy of ruxolitinib in this infection. The potential targets of ruxolitinib were determined by using genetic alterations that have been reported in COVID-19 patients. The potential effectiveness of ruxolitinib is suggested by evaluating the interactions of these potential targets with ruxolitinib or JAK/STAT pathway.
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Affiliation(s)
- Bakiye Goker Bagca
- Department of Medical Biology, Medical Faculty, Ege University, Izmir, Turkey.
| | - Cigir Biray Avci
- Department of Medical Biology, Medical Faculty, Ege University, Izmir, Turkey
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410
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Farkash EA, Wilson AM, Jentzen JM. Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2. J Am Soc Nephrol 2020; 31:1683-1687. [PMID: 32371536 PMCID: PMC7460898 DOI: 10.1681/asn.2020040432] [Citation(s) in RCA: 259] [Impact Index Per Article: 64.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A significant fraction of patients with coronavirus disease 2019 (COVID-19) display abnormalities in renal function. Retrospective studies of patients hospitalized with COVID-19 in Wuhan, China, report an incidence of 3%-7% progressing to ARF, a marker of poor prognosis. The cause of the renal failure in COVID-19 is unknown, but one hypothesized mechanism is direct renal infection by the causative virus, SARS-CoV-2. METHODS We performed an autopsy on a single patient who died of COVID-19 after open repair of an aortic dissection, complicated by hypoxic respiratory failure and oliguric renal failure. We used light and electron microscopy to examine renal tissue for evidence of SARS-CoV-2 within renal cells. RESULTS Light microscopy of proximal tubules showed geographic isometric vacuolization, corresponding to a focus of tubules with abundant intracellular viral arrays. Individual viruses averaged 76 µm in diameter and had an envelope studded with crown-like, electron-dense spikes. Vacuoles contained double-membrane vesicles suggestive of partially assembled virus. CONCLUSIONS The presence of viral particles in the renal tubular epithelium that were morphologically identical to SARS-CoV-2, and with viral arrays and other features of virus assembly, provide evidence of a productive direct infection of the kidney by SARS-CoV-2. This finding offers confirmatory evidence that direct renal infection occurs in the setting of AKI in COVID-19. However, the frequency and clinical significance of direct infection in COVID-19 is unclear. Tubular isometric vacuolization observed with light microscopy, which correlates with double-membrane vesicles containing vacuoles observed with electronic microscopy, may be a useful histologic marker for active SARS-CoV-2 infection in kidney biopsy or autopsy specimens.
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Affiliation(s)
- Evan A Farkash
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Allecia M Wilson
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Washtenaw County Medical Examiner's Office, Ann Arbor, Michigan
| | - Jeffrey M Jentzen
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Washtenaw County Medical Examiner's Office, Ann Arbor, Michigan
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411
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Rossi D, Shadman M, Condoluci A, Brown JR, Byrd JC, Gaidano G, Hallek M, Hillmen P, Mato A, Montserrat E, Ghia P. How We Manage Patients With Chronic Lymphocytic Leukemia During the SARS-CoV-2 Pandemic. Hemasphere 2020; 4:e432. [PMID: 32803132 PMCID: PMC7410019 DOI: 10.1097/hs9.0000000000000432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). These can be exacerbated by anti-leukemic treatments. In addition, the typical patients with CLL already have fragilities and background risk factors that apply to the general population for severe COVID-19. On these bases, patients with CLL may experience COVID-19 morbidity and mortality. Recurrent seasonal epidemics of SARS-CoV-2 are expected, and doctors taking care of patients with CLL must be prepared for the possibility of substantial resurgences of infection and adapt their approach to CLL management accordingly. In this Guideline Article, we aim at providing clinicians with a literature-informed expert opinion on the management of patients with CLL during SARS-CoV-2 epidemic.
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Affiliation(s)
- Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Laboratory of Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Mazyar Shadman
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Jennifer R. Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, Ohio, USA
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Michael Hallek
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Peter Hillmen
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
- Section of Experimental Haematology, University of Leeds, Leeds, United Kingdom
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emili Montserrat
- Hospital Clinic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Paolo Ghia
- Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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412
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Peng E, Xia D, Gao W, Zhan Y, Yang H, Yang X, Xu H, Qu X, Sun J, Wang S, Ye Z, Tang K, Chen Z. Risk Assessment and Prevention of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission for Hospitalized Urological Patients After the COVID-19 Pandemic in Wuhan, China. EUR UROL SUPPL 2020; 20:20-27. [PMID: 34173544 PMCID: PMC7392039 DOI: 10.1016/j.euros.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/07/2022] Open
Abstract
Background Emerging asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were detected and multiple cases were found to be SARS-CoV-2 positive again, which raised an alarm for the patients hospitalized after the coronavirus disease 2019 (COVID-19) pandemic. Objective We investigated the risk and prevention of hospital transmission of SARS-CoV-2 to hospitalized urological patients. Design, setting, and participants This is a retrospective study of 319 hospitalized urological patients enrolled between April 20, 2020 and May 11, 2020 from two tertiary hospitals in Wuhan, China. Intervention Chest computed tomography (CT) images, nucleic acid tests (NATs), and serum antibody were examined at the outpatient department and 1 wk after admission for all patients. Outcome measurements and statistical analysis The chest CT images, NATs, serum antibody results, and clinical data were collected and analyzed. Results and limitations None of the 319 patients was found to be SARS-CoV-2 NAT positive. Ten and four patients were detected to be immunoglobulin (Ig)G and IgM positive, respectively. The chest CT features of 116 patients showed abnormal lung findings. During the 1-wk isolation, one patient initially being IgG positive only was found to be IgM positive, and another initially IgM-positive patient had a rising IgG level. Through risk assessment, we identified seven patients with very high and high risk for hospital transmission, and delayed the surgery while maintaining close follow-up. Five intermediate-risk patients were operated on successfully under paravertebral block or epidural anesthesia to avoid opening the airway with endotracheal intubation. The remaining 104 low-risk and 203 normal patients underwent normal surgery. Conclusions Of the 319 patients, seven were identified as very high and high risk, which reinforced the importance of epidemic surveillance of discharged COVID-19 patients and asymptomatic infections. Five intermediate-risk patients were operated on successfully under regional anesthesia. Patient summary Our experience of risk assessment and management practice may provide a strategy to prevent severe acute respiratory syndrome coronavirus 2 transmission to hospitalized urological patients after the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenxi Gao
- Department of Urology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Ying Zhan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqi Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoling Qu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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413
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Andersson MI, Arancibia-Carcamo CV, Auckland K, Baillie JK, Barnes E, Beneke T, Bibi S, Brooks T, Carroll M, Crook D, Dingle K, Dold C, Downs LO, Dunn L, Eyre DW, Gilbert Jaramillo J, Harvala H, Hoosdally S, Ijaz S, James T, James W, Jeffery K, Justice A, Klenerman P, Knight JC, Knight M, Liu X, Lumley SF, Matthews PC, McNaughton AL, Mentzer AJ, Mongkolsapaya J, Oakley S, Oliveira MS, Peto T, Ploeg RJ, Ratcliff J, Robbins MJ, Roberts DJ, Rudkin J, Russell RA, Screaton G, Semple MG, Skelly D, Simmonds P, Stoesser N, Turtle L, Wareing S, Zambon M. SARS-CoV-2 RNA detected in blood products from patients with COVID-19 is not associated with infectious virus. Wellcome Open Res 2020; 5:181. [PMID: 33283055 PMCID: PMC7689603 DOI: 10.12688/wellcomeopenres.16002.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/13/2023] Open
Abstract
Background: Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood. Methods: We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=462 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples. Results: We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/494 (0%, 95%CI 0-0.7%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA. Conclusions: vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19.
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Affiliation(s)
- Monique I. Andersson
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Carolina V. Arancibia-Carcamo
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Kathryn Auckland
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - J. Kenneth Baillie
- Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Eleanor Barnes
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Tom Beneke
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Sagida Bibi
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Tim Brooks
- Porton Down, Public Health England, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, UK
| | - Miles Carroll
- Porton Down, Public Health England, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, UK
| | - Derrick Crook
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Kate Dingle
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Christina Dold
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Louise O. Downs
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Laura Dunn
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - David W. Eyre
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Big Data Institute, Roosevelt Drive, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Javier Gilbert Jaramillo
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Heli Harvala
- NHS Blood and Transfusion, 26 Margaret St, Marylebone, London, W1W 8NB, UK
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Sarah Hoosdally
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Samreen Ijaz
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Tim James
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Anita Justice
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Paul Klenerman
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Julian C. Knight
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Michael Knight
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Xu Liu
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Sheila F. Lumley
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Philippa C. Matthews
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Anna L. McNaughton
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Alexander J. Mentzer
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | | | - Sarah Oakley
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Marta S. Oliveira
- NHS Blood and Transplant, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Timothy Peto
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Rutger J. Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Jeremy Ratcliff
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Melanie J. Robbins
- Component Development Laboratory, NHS Blood and Transplant, Cambridge Donor Centre, Cambridge, CB2 0PT, UK
| | - David J. Roberts
- NHS Blood and Transplant, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Justine Rudkin
- Big Data Institute, Roosevelt Drive, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Nuffield Department of Population Health, University Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Rebecca A. Russell
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Gavin Screaton
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Donal Skelly
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Peter Simmonds
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Nicole Stoesser
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Susan Wareing
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Maria Zambon
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
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414
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Test, test, test - a complication of testing for coronavirus disease 2019 with nasal swabs. The Journal of Laryngology & Otology 2020; 134:646-649. [PMID: 32641170 PMCID: PMC7387789 DOI: 10.1017/s0022215120001425] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Coronavirus disease 2019, a highly transmissible respiratory infection, has created a public health crisis of global magnitude. The mainstay of diagnostic testing for coronavirus disease 2019 is molecular polymerase chain reaction testing of a respiratory specimen, obtained with a viral swab. As the incidence of new cases of coronavirus disease 2019 increases exponentially, the use of viral swabs to collect nasopharyngeal specimens is anticipated to increase drastically. Case report This paper draws attention to a complication of viral swab testing in the nasopharynx and describes the premature engagement of a viral swab breakpoint, resulting in impaction in the nasal cavity. Conclusion This case highlights a possible design flaw of the viral swab when used to collect nasopharyngeal specimens, which then requires an aerosol-generating procedure in a high-risk patient to be performed. The paper outlines a safe technique of nasal foreign body removal in a suspected coronavirus disease 2019 patient and suggests alternative testing materials.
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415
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Zarifian A, Zamiri Bidary M, Arekhi S, Rafiee M, Gholamalizadeh H, Amiriani A, Ghaderi MS, Khadem-Rezaiyan M, Amini M, Ganji A. Gastrointestinal and hepatic abnormalities in patients with confirmed COVID-19: A systematic review and meta-analysis. J Med Virol 2020; 93:336-350. [PMID: 32681674 PMCID: PMC7405277 DOI: 10.1002/jmv.26314] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
Although not common, gastrointestinal and liver symptoms have reportedly been the initial presentation of coronavirus disease‐2019 (COVID‐19) in a large group of patients. Therefore, knowing the frequency and characteristics of these manifestations of COVID‐19 is important for both clinicians and health policy makers. A systematic review and meta‐analysis of the available data on the gastrointestinal and liver manifestations of patients with COVID‐19 was performed. PubMed and Scopus databases and Google Scholar search engine were searched for published and unpublished preprint articles up to 10 April 2020. Original studies providing information on clinical digestive symptoms or biomarkers of liver function in patients with polymerase chain reaction confirmed diagnosis of COVID‐19 were included. After quality appraisal, data were extracted. Prevalence data from individual studies were pooled using a random‐effects model. Overall, 67 studies were included in this systematic review and meta‐analysis, comprising a pooled population of 13 251 patients with confirmed COVID‐19. The most common gastrointestinal symptoms were anorexia (10.2%, 95% confidence interval [CI] = 6.2%‐16.4%), diarrhea (8.4%, 95% CI = 6.2%‐11.2%), and nausea (5.7%, 95% CI = 3.7%‐8.6%), respectively. Decreased albumin levels (39.8%, 95% CI = 15.3%‐70.8%), increased aspartate aminotransferase (22.8%, 95% CI = 18.1%‐28.4%), and alanine aminotransferase (20.6%, 95% CI = 16.7%‐25.1%) were common hepatic findings. After adjusting for preexisting gastrointestinal (5.9%) and liver diseases (4.2%), the most common gastrointestinal findings were diarrhea (8.7%, 95% CI = 5.4%‐13.9%), anorexia (8.0%, 95% CI = 3.0%‐19.8%), and nausea (5.1%, 95% CI = 2.2%‐14.3%). Gastrointestinal and liver manifestations are not rare in patients with COVID‐19, but their prevalence might be affected by preexisting diseases. Diarrhea and mild liver abnormalities seem to be relatively common in COVID‐19, regardless of comorbidities Anorexia (10.2%), diarrhea (8.4%), and nausea (5.7%) were the most common gastrointestinal manifestations in confirmed COVID‐19 patients. Serum albumin reduction (39.8%), AST elevation (22.8%), and ALT elevation (20.6%) were the most common hepatic abnormalities in confirmed COVID‐19 patients. Preexisting gastrointestinal and liver diseases were present in 5.9% and 4.2% of COVID‐19 patients. After adjusting for these illnesses, diarrhea (8.7%) became the most prevalent gastrointestinal finding. The prevalence of gastrointestinal and hepatic abnormalities were markedly higher in patients with severe COVID‐19 infection, compared to non‐severe cases.
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Affiliation(s)
- Ahmadreza Zarifian
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Zamiri Bidary
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Arekhi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Rafiee
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Gholamalizadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhosein Amiriani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Sajjad Ghaderi
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahnaz Amini
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azita Ganji
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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416
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Mohammadi A, Esmaeilzadeh E, Li Y, Bosch RJ, Li JZ. SARS-CoV-2 detection in different respiratory sites: A systematic review and meta-analysis. EBioMedicine 2020; 59:102903. [PMID: 32718896 PMCID: PMC7380223 DOI: 10.1016/j.ebiom.2020.102903] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 01/03/2023] Open
Abstract
Background The accurate detection of SARS-CoV-2 through respiratory sampling is critical for the prevention of further transmission and the timely initiation of treatment for COVID-19. There is a diverse range of SARS-CoV-2 detection rates in reported studies, with uncertainty as to the optimal sampling strategy for COVID-19 diagnosis and monitoring. Methods We performed a systematic review and meta-analysis of studies comparing respiratory sampling strategies for the detection of SARS-CoV-2 RNA. The inclusion criteria were studies that assessed at least two respiratory sampling sites (oropharyngeal swab, nasopharyngeal swab, and sputum) in participants with COVID-19. The percentage positive tests were compared between sampling modalities by constructing a Z-test assuming independence and using the standard errors obtained from the random effects meta-analysis. Findings From 1039 total studies, we identified 11 studies that met our inclusion criteria, with SARS-CoV-2 testing results from a total of 3442 respiratory tract specimens. Compared to nasopharyngeal swab sampling, sputum testing resulted in significantly higher rates of SARS-CoV-2 RNA detection while oropharyngeal swab testing had lower rates of viral RNA detection. Earlier sampling after symptom onset was associated with improved detection rates, but the differences in SARS-CoV-2 RNA detection by sampling method was consistent regardless of the duration of symptoms. Interpretation The results support sputum sampling as a valuable method of COVID-19 diagnosis and monitoring, and highlight the importance of early testing after symptom onset to increase the rates of COVID-19 diagnosis. Funding This study was funded in part by the NIH grants U01AI106701 and by the Harvard University for AIDS Research (NIAID 5P30AI060354).
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Affiliation(s)
- Abbas Mohammadi
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yijia Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jonathan Z Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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417
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Multicenter Evaluation of the Cepheid Xpert Xpress SARS-CoV-2 Test. J Clin Microbiol 2020; 58:JCM.00926-20. [PMID: 32366669 PMCID: PMC7383535 DOI: 10.1128/jcm.00926-20] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/18/2022] Open
Abstract
Nucleic acid amplification tests (NAATs) are the primary means of identifying acute infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accurate and fast test results may permit more efficient use of protective and isolation resources and allow rapid therapeutic interventions. We evaluated the analytical and clinical performance characteristics of the Xpert Xpress SARS-CoV-2 (Xpert) test, a rapid, automated molecular test for SARS-CoV-2. Analytical sensitivity and specificity/interference were assessed with infectious SARS-CoV-2; other infectious coronavirus species, including SARS-CoV; and 85 nasopharyngeal swab specimens positive for other respiratory viruses, including endemic human coronaviruses (hCoVs). Nucleic acid amplification tests (NAATs) are the primary means of identifying acute infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accurate and fast test results may permit more efficient use of protective and isolation resources and allow rapid therapeutic interventions. We evaluated the analytical and clinical performance characteristics of the Xpert Xpress SARS-CoV-2 (Xpert) test, a rapid, automated molecular test for SARS-CoV-2. Analytical sensitivity and specificity/interference were assessed with infectious SARS-CoV-2; other infectious coronavirus species, including SARS-CoV; and 85 nasopharyngeal swab specimens positive for other respiratory viruses, including endemic human coronaviruses (hCoVs). Clinical performance was assessed using 483 remnant upper- and lower-respiratory-tract specimens previously analyzed by standard-of-care (SOC) NAATs. The limit of detection of the Xpert test was 0.01 PFU/ml. Other hCoVs, including Middle East respiratory syndrome coronavirus, were not detected by the Xpert test. SARS-CoV, a closely related species in the subgenus Sarbecovirus, was detected by a broad-range target (E) but was distinguished from SARS-CoV-2 (SARS-CoV-2-specific N2 target). Compared to SOC NAATs, the positive agreement of the Xpert test was 219/220 (99.5%), and the negative agreement was 250/261 (95.8%). A third tie-breaker NAAT resolved all but three of the discordant results in favor the Xpert test. The Xpert test provided sensitive and accurate detection of SARS-CoV-2 in a variety of upper- and lower-respiratory-tract specimens. The high sensitivity and short time to results of approximately 45 min may impact patient management.
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418
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Nakamoto T, Kutsuna S, Yanagawa Y, Kanda K, Okuhama A, Akiyama Y, Miyazato Y, Ide S, Nakamura K, Yamamoto K, Ohmagari N. A case of SARS-CoV-2 infection in an untreated HIV patient in Tokyo, Japan. J Med Virol 2020; 93:40-42. [PMID: 32492188 PMCID: PMC7300885 DOI: 10.1002/jmv.26102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Takato Nakamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuaki Yanagawa
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kouhei Kanda
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ayako Okuhama
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaro Akiyama
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Ide
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keiji Nakamura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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419
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Wang J, Cai K, Zhang R, He X, Shen X, Liu J, Xu J, Qiu F, Lei W, Wang J, Li X, Gao Y, Jiang Y, Xu W, Ma X. Novel One-Step Single-Tube Nested Quantitative Real-Time PCR Assay for Highly Sensitive Detection of SARS-CoV-2. Anal Chem 2020; 92:9399-9404. [PMID: 32438806 PMCID: PMC7299395 DOI: 10.1021/acs.analchem.0c01884] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become a public health emergency. The reverse transcriptase real-time quantitative PCR (qRT-PCR) test is currently considered as the gold standard in the laboratory for the etiological detection of COVID-19. However, qRT-PCR results could be false-negative due to the inadequate sensitivity of qRT-PCR. In this study, we have developed and evaluated a novel one-step single-tube nested quantitative real-time PCR (OSN-qRT-PCR) assay for the highly sensitive detection of SARS-CoV-2 targeting the ORF1ab and N genes. The sensitivity of the OSN-qRT-PCR assay was 1 copy/reaction and 10-fold higher than that of the commercial qRT-PCR kit (10 copies/reaction). The clinical performance of the OSN-qRT-PCR assay was evaluated using 181 clinical samples. Among them, 14 qRT-PCR-negative samples (7 had no repetitive results and 7 had no cycle threshold (CT) values) were detected by OSN-qRT-PCR. Moreover, the 7 qRT-PCR-positives in the qRT-PCR gray zone (CT values of ORF1ab ranged from 37.48 to 39.07, and CT values of N ranged from 37.34 to 38.75) were out of the gray zone and thus were deemed to be positive by OSN-qRT-PCR, indicating that the positivity of these samples is confirmative. Compared to the qRT-PCR kit, the OSN-qRT-PCR assay revealed higher sensitivity and specificity, showing better suitability to clinical applications for the detection of SARS-CoV-2 in patients with low viral load.
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Affiliation(s)
- Ji Wang
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Kun Cai
- Hubei Center for Disease
Control and Prevention, Wuhan 430000,
China
| | - Ruiqing Zhang
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
- Hebei General
Hospital, Shijiazhuang 050051,
China
| | - Xiaozhou He
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Xinxin Shen
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Jun Liu
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Junqiang Xu
- Hubei Center for Disease
Control and Prevention, Wuhan 430000,
China
| | - Feng Qiu
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Wenwen Lei
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Jinrong Wang
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
- Hebei Medical
University, Shijiazhuang 050031,
China
| | - Xinna Li
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Yuan Gao
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
- Hebei Medical
University, Shijiazhuang 050031,
China
| | - Yongzhong Jiang
- Hubei Center for Disease
Control and Prevention, Wuhan 430000,
China
| | - Wenbo Xu
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
| | - Xuejun Ma
- National Institute for
Viral Disease Control and Prevention, Chinese Center for Disease
Control and Prevention, Beijing 102206,
China
- Center for Biosafety Mega-Science,
Chinese Academy of Sciences, Wuhan
430071, China
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420
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Harahwa TA, Lai Yau TH, Lim-Cooke MS, Al-Haddi S, Zeinah M, Harky A. The optimal diagnostic methods for COVID-19. Diagnosis (Berl) 2020; 7:349-356. [DOI: 10.1515/dx-2020-0058] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
Abstract
As the world continues to study and understand coronavirus disease (COVID-19), existing investigations and tests have been used to try and detect the virus to slow viral transmission and its global spread. A ‘gold-standard’ investigation has not yet been identified for detection and monitoring. Initially, computed tomography (CT) was the mainstay investigation as it shows the disease severity and recovery, and its images change at different stages of the disease. However, CT has been found to have limited sensitivity and negative predictive value in the early stages of the disease, and the value of its use has come under debate due to whether its images change the treatment plan, the risk of radiation, as well as its practicality with infection control. Therefore, there has been a shift to the use of other imaging modalities and tests, such as chest X-rays and ultrasound. Furthermore, the use of nucleic acid-based testing such as reverse-transcriptase polymerase chain reaction (RT-PCR) have proven useful with direct confirmation of COVID-19 infection. In this study, we aim to review and analyse current literature to compare RT-PCR, immunological biomarkers, chest radiographs, ultrasound and chest CT scanning as methods of diagnosing COVID-19.
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Affiliation(s)
| | - Thomas Ho Lai Yau
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | | | - Salah Al-Haddi
- Department of Cardiothoracic Surgery , Liverpool Heart and Chest Hospital , Liverpool , UK
| | - Mohamed Zeinah
- Department of Cardiothoracic Surgery , Liverpool Heart and Chest Hospital , Liverpool , UK
| | - Amer Harky
- Department of Cardiothoracic Surgery , Liverpool Heart and Chest Hospital , Liverpool , UK
- Department of Integrative Biology , University of Liverpool , Liverpool , UK
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421
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Wiseman J, D'Amico TA, Zawadzka S, Anyimadu H. False negative SARS-CoV-2 PCR - A case report and literature review. Respir Med Case Rep 2020; 31:101140. [PMID: 32714821 PMCID: PMC7369610 DOI: 10.1016/j.rmcr.2020.101140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
The first case of the novel Coronavirus Diseases (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was detected in Wuhan, China in December 2019. On January 30, 2020, the World Health Organization declared a global health emergency. Countries around the world advised social distancing, businesses and schools closed, while health care workers faced a viral war. With the declaration of a global emergency, a test to rapidly detect the SARS-CoV-2 was developed to ensure swift isolation of infected persons to prevent spread of disease. Currently, the gold standard for test is Reverse Transcriptase Polymerase Chain Reaction (RT-PCR); however, patients with a high clinical suspicion for COVID-19 can sometimes have multiple negative tests. We discuss a patient under investigation (PUI) who had classic findings of COVID-19 but repeatedly tested negative from nasopharyngeal swabs until a fifth sample obtained from a deep suctioning was tested.
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Affiliation(s)
- Jessica Wiseman
- University of Connecticut Primary Care Internal Medicine Residency Program, University of Connecticut School of Medicine, UConn Health Center, Farmington, CT, United States
| | - Timothy A D'Amico
- University of Connecticut Primary Care Internal Medicine Residency Program, University of Connecticut School of Medicine, UConn Health Center, Farmington, CT, United States
| | - Sabina Zawadzka
- University of Connecticut Infectious Disease Fellowship, University of Connecticut School of Medicine, UConn Health Center, Farmington, CT, United States
| | - Henry Anyimadu
- Hartford HealthCare Medical Group, Department of Infectious Diseases, New Britain, CT, United States
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422
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Yu C, Li L, Tuersun Y, Zhao X, Feng Q, Zhang T, Tay FR, Ma J. Oropharyngeal Secretion as Alternative for SARS-CoV-2 Detection. J Dent Res 2020; 99:1199-1205. [PMID: 32613877 DOI: 10.1177/0022034520940292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This study aimed to determine if sampling of oropharyngeal secretions (OSs) helps improves detection of SARS-CoV-2 RNA by nucleic acid amplification testing of potential patients with COVID-19. The first prospective study consisted of 75 patients with COVID-19 who were ready for discharge and who had 2 consecutive negative results per nucleic acid amplification testing (NAAT) of viral samples retrieved with nasopharyngeal swabs (NPSs). Because of detection of potential false negatives in that cohort, the NAAT results of paired OS and NPS samples from 50 additional recruits with COVID-19 during their recovery stage were used in a second prospective study to compare the diagnostic values of the 2 viral RNA sampling methods. For identification of the frequency of inconsistency between the sampling methods, the McNemar's test was used for difference analysis and the kappa statistic for consistency analysis. OSs obtained from 2 of the 75 participants in the first study yielded positive results for SARS-CoV-2 nucleic acid. Both were male and aged >60 y. Subsequent chemiluminescence enzyme immunoassays indicated that they were positive for the SARS-CoV-2 IgM and IgG antibodies. For parallel NAAT of OS and NPS samples in the second study, McNemar's test indicated that the difference between the frequencies of inconsistent parts of OS and NPS was statistically significant (P = 0.021). Cohen's kappa coefficient for OS and NPS was 0.244, which is indicative of fair consistency. The NPS test has a risk of sending home more patients (59%) who still have the infection, while the OS test will make such an error in fewer patients (14%). Although OS sampling improves the accuracy of SARS-CoV-2 nucleic acid testing, it has to be emphasized that this conclusion is based on a very small sample size. Detection of viral RNA from a patient's secretions is not confirmative of viral infectivity.
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Affiliation(s)
- C Yu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - L Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y Tuersun
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - X Zhao
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Q Feng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - T Zhang
- Department of Stomatology, Chinese PLA General Hospital, Beijing, China
| | - F R Tay
- The Graduate School, Augusta University, Augusta, GA, USA
| | - J Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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423
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Carugno J, Di Spiezio Sardo A, Alonso L, Haimovich S, Campo R, De Angelis C, Bradley L, Bettocchi S, Arias A, Isaacson K, Okohue J, Farrugia M, Kumar A, Xue X, Cavalcanti L, Laganà AS, Grimbizis G. COVID-19 Pandemic. Impact on Hysteroscopic Procedures: A Consensus Statement from the Global Congress of Hysteroscopy Scientific Committee. J Minim Invasive Gynecol 2020; 27:988-992. [PMID: 32339754 PMCID: PMC7194569 DOI: 10.1016/j.jmig.2020.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, FL.
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples, "Federico II" Naples, Italy
| | - Luis Alonso
- Centro Gutenberg, Endoscopy Unit, Malaga, Spain
| | - Sergio Haimovich
- Hillel Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, Technion, Israel
| | | | - Carlo De Angelis
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Stefano Bettocchi
- II Unit of Obstetrics and Gynecology, Department DIM, University "Aldo Moro," Policlinico of Bari, Bari, Italy
| | - Alfonso Arias
- Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Keith Isaacson
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Jude Okohue
- Department of Obstetrics and Gynecology, Madonna University Teaching Hospital, Elele, Rivers State, Nigeria
| | | | - Alka Kumar
- Hysteroscopic Surgery Division, Women's Health Centre, Jaipur, India
| | - Xiang Xue
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Luiz Cavalcanti
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Grigoris Grimbizis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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424
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Razonable RR, Pennington KM, Meehan AM, Wilson JW, Froemming AT, Bennett CE, Marshall AL, Virk A, Carmona EM. A Collaborative Multidisciplinary Approach to the Management of Coronavirus Disease 2019 in the Hospital Setting. Mayo Clin Proc 2020; 95:1467-1481. [PMID: 32622450 PMCID: PMC7260518 DOI: 10.1016/j.mayocp.2020.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which presents an unprecedented challenge to medical providers worldwide. Although most SARS-CoV-2-infected individuals manifest with a self-limited mild disease that resolves with supportive care in the outpatient setting, patients with moderate to severe COVID-19 will require a multidisciplinary collaborative management approach for optimal care in the hospital setting. Laboratory and radiologic studies provide critical information on disease severity, management options, and overall prognosis. Medical management is mostly supportive with antipyretics, hydration, oxygen supplementation, and other measures as dictated by clinical need. Among its medical complications is a characteristic proinflammatory cytokine storm often associated with end-organ dysfunction, including respiratory failure, liver and renal insufficiency, cardiac injury, and coagulopathy. Specific recommendations for the management of these medical complications are discussed. Despite the issuance of emergency use authorization for remdesivir, there are still no proven effective antiviral and immunomodulatory therapies, and their use in COVID-19 management should be guided by clinical trial protocols or treatment registries. The medical care of patients with COVID-19 extends beyond their hospitalization. Postdischarge follow-up and monitoring should be performed, preferably using telemedicine, until the patients have fully recovered from their illness and are released from home quarantine protocols.
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Key Words
- agp, aerosol-generating procedure
- aki, acute kidney injury
- alt, alanine aminotransferase
- ards, acute respiratory distress syndrome
- ast, aspartate aminotransferase
- cbc, complete blood cell
- cdc, centers for disease control and prevention
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- ecg, electrocardiogram
- esr, erythrocyte sedimentation rate
- fda, food and drug administration
- ggo, ground-glass opacity
- hrct, high-resolution computed tomography
- icu, intensive care unit
- il, interleukin
- ldh, lactate dehydrogenase
- lft, liver function test
- pcr, polymerase chain reaction
- rsv, respiratory syncytial virus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
| | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Anne M Meehan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - John W Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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425
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Malek AE, Gutierrez C, Mulanovich VE, Botdorf J, Chemaly RF, Shah S, McCall BM, Melancon JT, McConn KK, Borjan J, Raad II, Burger JA, Garcia-Manero G, Adachi JA. Successful Outcomes of Severe COVID-19 in Patient with Chronic Lymphocytic Leukemia: Diagnostic Challenges in Immunocompromised Hosts. Mediterr J Hematol Infect Dis 2020; 12:e2020044. [PMID: 32670522 PMCID: PMC7340251 DOI: 10.4084/mjhid.2020.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
The emergence and spread of 2019 novel coronavirus have led to an unprecedented public health crisis around the globe, threatening the lives of millions of people. We report a severe case of COVID-19 in a patient with chronic lymphocytic leukemia and describe primarily the clinical presentation and the challenges encountered in the COVID-19 diagnosis, treatment, and specimens sampling pitfalls. This case highlights the importance of a comprehensive diagnostic approach of pneumonia in immunocompromised hosts, including timely and safe bronchoscopy, because of the broad differential diagnosis, more challenging with the current outbreak of COVID-19.
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Affiliation(s)
- Alexandre E. Malek
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Cristina Gutierrez
- Department of Critical Care Department; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Victor E. Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Joshua Botdorf
- Department of Critical Care Department; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Shivan Shah
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Brandi M. McCall
- Department of Critical Care Department; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Judd T. Melancon
- Department of Critical Care Department; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Kelly K. McConn
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Jovan Borjan
- Division of Pharmacy; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Issam I. Raad
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Jan A. Burger
- Department of Leukemia; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia; The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Javier A. Adachi
- Department of Infectious Diseases, Infection Control and Employee Health. The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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426
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Mahlke L, Flohé S, Matthes G, Paffrath T, Wagner F, Wölfl C. [Surgery during the SARS-CoV-2 pandemic : Recommendations on operative procedures]. Unfallchirurg 2020; 123:571-578. [PMID: 32488319 PMCID: PMC7265879 DOI: 10.1007/s00113-020-00830-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In February 2020 Germany was also hit by the SARS-CoV‑2 pandemic. Even patients infected by SARS-CoV‑2 or COVID-19 may need operative procedures. Currently, no uniform recommendations exist on precautions to be taken when operating on these patients. Furthermore, they may differ from one hospital to another. METHODS The task force COVID-19 of the emergency, intensive and severely injured section of the German Trauma Society (DGU e. V.) has developed consensus-based recommendations on surgical treatment of patients with SARS-CoV‑2 infections. Great importance is placed on the implementation in hospitals at all levels of care. RESULTS The indications for surgical interventions in patients with COVID-19 infections require an extremely critical evaluation. When indicated these surgical intervention should ideally be performed in a separate operating theater. All personnel involved should wear personal protective equipment with FFP2 masks, face shields and double gloves. The emergency team in the resuscitation bay should generally wear the same personal protective equipment. Special training is mandatory and the exposure of team members should be minimized. CONCLUSION The recommendations are principally used for all kinds of surgery and comply with the currently available knowledge. Nevertheless, all recommendations represent a compromise between maximum safety of all medical staff and practicability in the routine hospital workflow.
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Affiliation(s)
- Lutz Mahlke
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, St. Vincenz-Krankenhaus GmbH, Am Busdorf 2, 33098, Paderborn, Deutschland.
| | - Sascha Flohé
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städtisches Klinikum Solingen GmbH, Solingen, Deutschland
| | - Gerrit Matthes
- Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Thomas Paffrath
- Sektion Unfallchirurgie, Klinik für Allgemein‑, Viszeral‑, Thorax- und Unfallchirurgie, Krankenhaus der Augustinerinnen gGmbH, Köln, Deutschland
| | - Frithjof Wagner
- Abteilung für septische und rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Christoph Wölfl
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhausklinikum Hetzelstift, Neustadt an der Weinstraße, Deutschland
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427
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Gaddi AV, Capello F, Aluigi L, Antignani PL, Callegaro A, Casu G, Cipolla E, Cipolla M, Cosco L, Culzoni F, Dentali F, Elexpuru-Zabaleta M, Forbes-Hernandez TY, Fragiacomo C, Giampieri F, Gnasso A, Mancini R, Modena MG, Nichelatti M, Paradiso AV, Ortasi P, Savo MT, Tangianu F, Tempesta S, Voci TD, Battino M. The Strategic Alliance between Clinical and Molecular Science in the War against SARS-CoV-2, with the Rapid-Diagnostics Test as an Indispensable Weapon for Front Line Doctors. Int J Mol Sci 2020; 21:E4446. [PMID: 32580529 PMCID: PMC7352982 DOI: 10.3390/ijms21124446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
Our work concerns the actual problem of spread of SARS- CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for epidemiologic one. The right equilibrium between high speed, low cost and accuracy is obtained with easy-to-use decentralized point-of-care test as the colloidal gold-based immunochromatographic strip assay which detects IgM and IgG antibodies directed against SARS-CoV-2. As our aim is to evaluate the efficacy of Covid-19 rapid tests and of serological assays in real-life settings, we designed a research protocol aimed to establish how to use correctly these diagnostics, taking into account the different possible clinical and epidemiological scenarios.
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Affiliation(s)
| | - Fabio Capello
- International Study Center of Society of Telemedicine and Digital Health, 40100 Bologna, Italy;
| | | | | | - Annapaola Callegaro
- Department of Laboratory Medicine ASST-Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Gavino Casu
- Cardiology Dept. – ATS Sardegna ASSL, San Francesco Hospital, 08100 Nuoro, Italy;
| | - Enrico Cipolla
- Alma Mater Studiorum Università di Bologna, 40126 Bologna, Italy;
| | - Maurizio Cipolla
- UCCP Catanzaro Lido, ASP Catanzaro; Calabria Society of Telemedicine-Regione Calabria, 88100 Catanzaro, Italy;
| | - Lucio Cosco
- Infectious Disease Department., “Pugliese-Ciaccio” Hospital, 88100 Catanzaro, Italy;
| | | | - Francesco Dentali
- Department of Clinical Medicine Insubria University Varese, 21100 Varese, Italy;
| | - Maria Elexpuru-Zabaleta
- Dipartimento di Scienze Cliniche e Molecolari, Facoltà di Medicina, Università Politecnica delle Marche, 60131 Ancona, Italy;
| | - Tamara Y. Forbes-Hernandez
- Nutrition and Food Science Group, department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo-Vigo Campus, 32004 Vigo, Spain; (T.Y.F.-H.); (F.G.)
| | | | - Francesca Giampieri
- Nutrition and Food Science Group, department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo-Vigo Campus, 32004 Vigo, Spain; (T.Y.F.-H.); (F.G.)
- Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, Università Politecnica delle Marche, Via Ranieri 65, 60130 Ancona, Italy
- College of Food Science and Technology, Northwest University, Xi’an 710069, China
| | - Agostino Gnasso
- Department of Applied Medical Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | | | - Maria Grazia Modena
- Surgical, Medical, Dental and Morphological Science Department with Transplantology, Oncological and Rigenerative Address, Modena e Reggio Emilia University, 41125 AOU Modena, Italy;
| | - Michele Nichelatti
- Service of Statistics, Fondazione Malattie del Sangue Niguarda Hospital, 20162 Milano, Italy;
| | | | - Pasquale Ortasi
- Primary health care Department, ASL Area Vasta Romagna, National Medical Interdisciplinary Primary health care Ravenna-Forlì-Cesena, Society of Digital Health and Telemedicine, Emilia Romagna, 48121 Ravenna, Italy;
| | - Maria Teresa Savo
- Dipartimento di Medicina Interna, University of Florence, 50134 Firenze, Italy
| | - Flavio Tangianu
- ASST Settelaghi Varese, Medical and Surgical Department, Insubria University, 21100 Varese, Italy;
| | - Sergio Tempesta
- Technobios Prenatale Eurogenlab-Caravelli Group, Medical Genetics Laboratory, 40126 Bologna, Italy;
| | - Tommaso Diego Voci
- Associazione Interregionale Cardiologi e Specialisti Medici Ambulatoriali, ACSA, 10125 Torino, Italy;
| | - Maurizio Battino
- Nutrition and Food Science Group, department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo-Vigo Campus, 32004 Vigo, Spain; (T.Y.F.-H.); (F.G.)
- Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, Università Politecnica delle Marche, Via Ranieri 65, 60130 Ancona, Italy
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
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428
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Deng W, Guang TW, Yang M, Li JR, Jiang DP, Li CY, Wang DX. Positive results for patients with COVID-19 discharged form hospital in Chongqing, China. BMC Infect Dis 2020; 20:429. [PMID: 32560694 PMCID: PMC7303931 DOI: 10.1186/s12879-020-05151-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since December 2019, over 80,000 patients with coronavirus disease 2019 (COVID-19) have been confirmed in China. With the increasing number of recovered patients, more attention should be paid to the follow-up of these patients. METHODS In the study, 576 patients with COVID-19 discharged from hospital in Chongqing, China from January 24, 2020, to March 10, 2020 were evaluated by viral nucleic acid tests for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) to determine if they could be released from quarantine. Among the 576 patients, 61 patients (10.6%) had positive RT-PCR test results of SARS-CoV-2. We aimed to analyze the demographics, clinical characteristics and treatment of 61 patients. RESULTS These positive patients were characterized by older age, chronic medical illness and mild conditions. 38 (62.3%) patients who were asymptomatic without abnormalities on chest radiographs were found in the positive with COVID-19. Also, they showed positive results of stool or sputum specimens with negative results of nasal and pharyngeal swab specimens. The median duration of positive result of SARS-CoV-2 was varied from 3 days to 35 days in the patients discharged from hospital with no family member infection. CONCLUSIONS Multi-site screening of SARS-CoV-2 including nasal and pharyngeal swabs, stool and sputum specimens could be considered to improve the diagnosis, treatment and infection control in patients with COVID-19. Our findings provide the important information and clinical evidence for the improved management of patients recovered from COVID-19.
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Affiliation(s)
- Wang Deng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010 China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, 400010 China
| | - Tian-wen Guang
- Department of Infectious Disease, Yongchuan Affiliated Hospital of Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing, 402160 China
| | - Mei Yang
- Department of Respiratory Medicine, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036 China
| | - Jian-rong Li
- Department of Respiratory Medicine, Wanzhou General Hospital, 27 Guoben Road, Wanzhou District, Chongqing, 404100 China
| | - De-peng Jiang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010 China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, 400010 China
| | - Chang-yi Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010 China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, 400010 China
| | - Dao-xin Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010 China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, 400010 China
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429
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Daigle P, Leung V, Yin V, Kalin-Hajdu E, Nijhawan N. Personal protective equipment (PPE) during the COVID-19 pandemic for oculofacial plastic and orbital surgery. Orbit 2020; 40:281-286. [PMID: 32552229 DOI: 10.1080/01676830.2020.1781200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: To review the current literature on Coronavirus Disease 2019 (COVID-19) virology and transmission; to present a decision tree for risk stratifying oculofacial plastic and orbital surgeries; and to generate personal protective equipment (PPE) recommendations by risk category.Methods: A comprehensive literature review on COVID-19 was conducted. A two-stage modified Delphi technique involving 18 oculofacial plastic and orbital surgeons across Canada was used to determine consensus risk-stratification criteria and PPE recommendations for surgeries performed in the North American context.Results: COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We summarize COVID-19 virology and transmission, as well as practice considerations for oculofacial plastic and orbital surgeons. Although SARS-CoV-2 is known to be transmitted predominantly by droplet mechanisms, some studies suggest that transmission is possible through aerosols. Among common procedures performed by oculofacial and plastic surgeons, some are likely to be considered aerosol-generating. Risk of transmission increases when manipulating structures known to harbor high viral loads. We present an algorithm for risk-stratification based on the nature of surgery and the anatomical sites involved and offer recommendations for PPE.Conclusions: Although universal droplet precautions are now recommended in most healthcare settings, some clinical situations require more stringent infection control measures. By highlighting high-risk scenarios specific to oculofacial plastic and orbital surgery, as well as PPE recommendations, we hope to enhance the safety of continued care during the COVID-19 pandemic.
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Affiliation(s)
- Patrick Daigle
- Department of Ophthalmology and Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Victoria Leung
- Department of Ophthalmology and Vision Sciences, CUO Maisonneuve-Rosemont, Université De Montréal, Montréal, QC, Canada
| | - Vivian Yin
- Department of Ophthalmology and Vision Sciences, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Evan Kalin-Hajdu
- Department of Ophthalmology and Vision Sciences, CUO Maisonneuve-Rosemont, Université De Montréal, Montréal, QC, Canada
| | - Navdeep Nijhawan
- Department of Ophthalmology and Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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430
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Bird P, Badhwar V, Fallon K, Kwok KO, Tang JW. High SARS-CoV-2 infection rates in respiratory staff nurses and correlation of COVID-19 symptom patterns with PCR positivity and relative viral loads. J Infect 2020; 81:452-482. [PMID: 32562793 PMCID: PMC7299866 DOI: 10.1016/j.jinf.2020.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Paul Bird
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Vinay Badhwar
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Karlie Fallon
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China
| | - Julian W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Respiratory Sciences, University of Leicester, Leicester, United Kingdom
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431
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Hanson KE, Caliendo AM, Arias CA, Englund JA, Lee MJ, Loeb M, Patel R, El Alayli A, Kalot MA, Falck-Ytter Y, Lavergne V, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19. Clin Infect Dis 2020:ciaa760. [PMID: 32556191 PMCID: PMC7337674 DOI: 10.1093/cid/ciaa760] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19). Direct detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acids in respiratory tract specimens informs patient, healthcare institution and public health level decision-making. The numbers of available SARS-CoV-2 nucleic acid detection tests are rapidly increasing, as is the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) recognized a significant need for frequently updated systematic reviews of the literature to inform evidence-based best practice guidance. OBJECTIVE The IDSA's goal was to develop an evidence-based diagnostic guideline to assists clinicians, clinical laboratorians, patients and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss the nuance of test result interpretation in a variety of practice settings, and highlight important unmet research needs in the COVID-19 diagnostic testing space. METHODS IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel agreed on 15 diagnostic recommendations. CONCLUSIONS Universal access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention and the public response to the COVID-19 pandemic. Information on the clinical performance of available tests is rapidly emerging, but the quality of evidence of the current literature is considered low to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is recommended for asymptomatic individuals with known or suspected contact with a COVID-19 case. Testing asymptomatic individuals without known exposure is suggested when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions, dictate eligibility for surgery, or inform administration of immunosuppressive therapy. Ultimately, prioritization of testing will depend on institutional-specific resources and the needs of different patient populations.
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Affiliation(s)
- Kimberly E Hanson
- Department of Internal Medicine and Pathology, University of Utah, Salt Lake City, Utah
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cesar A Arias
- Division of Infectious Diseases, Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health McGovern Medical School, Center for Infectious Diseases, University of Texas Health School of Public Health, Houston, TX
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, Washington
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina
| | - Mark Loeb
- Divinsion of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Abdallah El Alayli
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mohamad A Kalot
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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432
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Review of Viral Testing (Polymerase Chain Reaction) and Antibody/Serology Testing for Severe Acute Respiratory Syndrome-Coronavirus-2 for the Intensivist. Crit Care Explor 2020; 2:e0154. [PMID: 32696013 PMCID: PMC7314351 DOI: 10.1097/cce.0000000000000154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: As the severe acute respiratory syndrome-coronavirus-2 pandemic develops, assays to detect the virus and infection caused by it are needed for diagnosis and management. To describe to clinicians how each assay is performed, what each assay detects, and the benefits and limitations of each assay. Data Sources: Published literature and internet. Study Selection: As well done, relevant and recent as possible. Data Extraction: Sources were read to extract data from them. Data Synthesis: Was synthesized by all coauthors. Conclusions: Available assays test for current or previous severe acute respiratory syndrome-coronavirus-2 infection. Nucleic acid assays such as quantitative, or real-time, polymerase chain reaction and loop-mediated isothermal amplification are ideal for acute diagnosis with polymerase chain reaction testing remaining the “gold standard” to diagnose acute infection by severe acute respiratory syndrome-coronavirus-2, specifically the presence of viral RNA. Assays that detect serum antibodies can theoretically diagnose both acute and remote infection but require time for the patient to develop immunity and may detect nonspecific antibodies. Antibody assays that quantitatively measure neutralizing antibodies are needed to test efficacy of convalescent plasma therapy but are more specialized.
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433
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Weissleder R, Lee H, Ko J, Pittet MJ. COVID-19 diagnostics in context. Sci Transl Med 2020; 12:12/546/eabc1931. [PMID: 32493791 DOI: 10.1126/scitranslmed.abc1931] [Citation(s) in RCA: 237] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for different types of diagnostics, comparative validation of new tests, faster approval by federal agencies, and rapid production of test kits to meet global demands. In this Perspective, we discuss the utility and challenges of current diagnostics for COVID-19.
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Affiliation(s)
- Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA 02114, USA. .,Department of Systems Biology, Harvard Medical School, Boston, MA 02115, USA.,Division of Interventional Radiology, Massachusetts General Hospital, Fruit Street, Boston, MA 02114, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA 02114, USA
| | - Jina Ko
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA 02114, USA
| | - Mikael J Pittet
- Center for Systems Biology, Massachusetts General Hospital Research Institute, Boston, MA 02114, USA
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434
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Dai Q, Hu S, Yan K, Chen Z, Chen B, Cai T, Zhang S, Zhang J, Zheng J. Reflection on SARS-CoV-2 infection of container ship seafarers. Travel Med Infect Dis 2020; 36:101787. [PMID: 32531421 PMCID: PMC7283070 DOI: 10.1016/j.tmaid.2020.101787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Qi Dai
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Supei Hu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China; Ningbo Institute of Life and Health, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Kun Yan
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Zhang Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Bin Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Ting Cai
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China; Ningbo Institute of Life and Health, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Shun Zhang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China
| | - Jingfeng Zhang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China; Ningbo Institute of Life and Health, University of Chinese Academy of Sciences, 315010, Ningbo, PR China.
| | - Jianjun Zheng
- Hwa Mei Hospital, University of Chinese Academy of Sciences, 315010, Ningbo, PR China; Ningbo Institute of Life and Health, University of Chinese Academy of Sciences, 315010, Ningbo, PR China.
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435
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Lamb CR, Desai NR, Angel L, Chaddha U, Sachdeva A, Sethi S, Bencheqroun H, Mehta H, Akulian J, Argento AC, Diaz-Mendoza J, Musani A, Murgu S. Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report. Chest 2020; 158:1499-1514. [PMID: 32512006 PMCID: PMC7274948 DOI: 10.1016/j.chest.2020.05.571] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/19/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs). Methods A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report. Results Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure. Conclusion This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.
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Affiliation(s)
- Carla R Lamb
- Department of Medicine, Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, MA
| | - Neeraj R Desai
- Chicago Chest Center, AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
| | - Luis Angel
- Department of Medicine, Division of Pulmonary and Critical Care, New York University Langone Health, NY
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashutosh Sachdeva
- Department of Medicine, Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD
| | - Sonali Sethi
- Respiratory Institute, Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, OH
| | - Hassan Bencheqroun
- Department of Medicine, Division of Pulmonary and Critical Care, University of California Riverside, CA
| | - Hiren Mehta
- Division of Pulmonary and Critical Care and Sleep Medicine, University of Florida, FL
| | - Jason Akulian
- Division of Pulmonary and Critical Care, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC
| | - A Christine Argento
- Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Javier Diaz-Mendoza
- Division of Pulmonary and Critical Care, Henry Ford Hospital and Department of Medicine, Wayne State University, Detroit, MI
| | - Ali Musani
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL.
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436
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Abstract
This study aimed to investigate the clinical characteristics and to analyse the epidemiological features of coronavirus disease 2019 (COVID-19) patients during convalescence. In this study, we enrolled 71 confirmed cases of COVID-19 who were discharged from hospital and transferred to isolation wards from 6 February to 26 March 2020. They were all employees of Zhongnan Hospital of Wuhan University or their family members of which three cases were <18 years of age. Clinical data were collected and analysed statistically. Forty-one cases (41/71, 57.7%) comprised medical faculty, young and middle-aged patients (aged ⩽60 years) accounted for 81.7% (58/71). The average isolation time period for all adult patients was 13.8 ± 6.1 days. During convalescence, RNA detection results of 35.2% patients (25/71) turned from negative to positive. The longest RNA reversed phase time was 7 days. In all, 52.9% of adult patients (36/68) had no obvious clinical symptoms, and the remaining ones had mild and non-specific clinical symptoms (e.g. cough, sputum, sore throat, disorders of the gastrointestinal tract etc.). Chest CT signs in 89.7% of adult patients (61/68) gradually improved, and in the others, the lesions were eventually absorbed and improved after short-term repeated progression. The main chest CT manifestations of adult patients were normal, GGO or fibre streak shadow, and six patients (8.8%) had extrapulmonary manifestations, but there was no significant correlation with RNA detection results (r = −0.008, P > 0.05). The drug treatment was mainly symptomatic support therapy, and antibiotics and antiviral drugs were ineffective. It is necessary to re-evaluate the isolation time and standard to terminate isolation for discharged COVID-19 patients.
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437
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Howard BE, Lal D. Rhinologic Practice Special Considerations During COVID-19: Visit Planning, Personal Protective Equipment, Testing, and Environmental Controls. Otolaryngol Head Neck Surg 2020; 163:676-681. [PMID: 32484728 DOI: 10.1177/0194599820933169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
As rhinologists return to practice amid SARS-CoV-2, special considerations are warranted given the unique features of their subspecialty. Rhinologist manipulation of nasal tissue, proximity, and frequent aerosol-generating procedures (AGPs) create high risk for infection transmission. There are 4 areas of special consideration to mitigate risk: (1) previsit planning for risk stratification/mitigation, (2) appropriate personal protective equipment, (3) preprocedural testing, and (4) environmental controls. During previsit planning, risk factors of the patient and procedures are considered. High-risk AGPs are identified by duration, proximity, manipulation of high-viral load tissue, and use of powered instrumentation. Appropriate personal protective equipment includes selection of respiratory and eye protection. COVID-19 testing can screen for asymptomatic carriers prior to high-risk procedures; however, alternative testing methods are required in rhinologic patients not eligible for nasopharyngeal testing due to nasal obstruction or skull base defects. Last, AGPs in rhinologic practices require considerations of room air handling and environmental controls.
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Affiliation(s)
- Brittany E Howard
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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438
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Lee S, Meyler P, Mozel M, Tauh T, Merchant R. Asymptomatic carriage and transmission of SARS-CoV-2: What do we know? Can J Anaesth 2020; 67:1424-1430. [PMID: 32488493 PMCID: PMC7266417 DOI: 10.1007/s12630-020-01729-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Risk to healthcare workers treating asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the operating room depends on multiple factors. This review examines the evidence for asymptomatic or pre-symptomatic carriage of SARS-CoV-2, the risk of transmission from asymptomatic patients, and the specific risks associated with aerosol-generating procedures. Protective measures, such as minimization of aerosols and use of personal protective equipment in the setting of treating asymptomatic patients, are also reviewed. Source We examined the published literature as well as Societal guidelines. Principal findings There is evidence that a proportion of those infected with SARS-CoV-2 have detectable viral loads prior to exhibiting symptoms, or without ever developing symptoms. The degree of risk of transmission from asymptomatic patients to healthcare providers will depend on the prevalence of disease in the population, which is difficult to assess without widespread population screening. Aerosol-generating procedures increase the odds of viral transmission from infected symptomatic patients to healthcare providers, but transmission from asymptomatic patients has not been reported. Techniques to minimize aerosolization and appropriate personal protective equipment may help reduce the risk to healthcare workers in the operating room. Some societal guidelines recommend the use of airborne precautions during aerosol-generating procedures on asymptomatic patients during the coronavirus disease pandemic, although evidence supporting this practice is limited. Conclusion Viral transmission from patients exhibiting no symptoms in the operating room is plausible and efforts to reduce risk to healthcare providers include reducing aerosolization and wearing appropriate personal protective equipment, the feasibility of which will vary based on geographic risk and equipment availability.
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Affiliation(s)
- Susan Lee
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada.
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada.
| | - Paula Meyler
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
| | - Michelle Mozel
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
| | - Tonia Tauh
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
| | - Richard Merchant
- Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 E Columbia, New Westminster, BC, V3L 3W7, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, BC, Canada
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439
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La Scola B, Le Bideau M, Andreani J, Hoang VT, Grimaldier C, Colson P, Gautret P, Raoult D. Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards. Eur J Clin Microbiol Infect Dis 2020; 39:1059-1061. [PMID: 32342252 PMCID: PMC7185831 DOI: 10.1007/s10096-020-03913-9] [Citation(s) in RCA: 663] [Impact Index Per Article: 165.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022]
Abstract
In a preliminary clinical study, we observed that the combination of hydroxychloroquine and azithromycin was effective against SARS-CoV-2 by shortening the duration of viral load in Covid-19 patients. It is of paramount importance to define when a treated patient can be considered as no longer contagious. Correlation between successful isolation of virus in cell culture and Ct value of quantitative RT-PCR targeting E gene suggests that patients with Ct above 33-34 using our RT-PCR system are not contagious and thus can be discharged from hospital care or strict confinement for non-hospitalized patients.
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Affiliation(s)
- Bernard La Scola
- IHU-Méditerranée Infection, Marseille, France.
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.
| | - Marion Le Bideau
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Julien Andreani
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Van Thuan Hoang
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Clio Grimaldier
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Philippe Colson
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France.
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France.
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440
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The influenza virus, SARS-CoV-2, and the airways: Clarification for the otorhinolaryngologist. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:291-296. [PMID: 32507410 PMCID: PMC7261469 DOI: 10.1016/j.anorl.2020.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The influenza virus and SARS-CoV-2 cause trivial upper and severe lower respiratory infections (Influenza virus 290,000 to 650,000 deaths/year). These viruses come into contact with the airways either by direct projection, by secondary inhalation of airborne droplets, or by handling (fomites). The objective of this article is to clarify the mechanisms of production and penetration of droplets of secretions emitted during all expiratory phenomena likely to transport these viruses and come into contact with the respiratory mucosa. The droplets>5μm follow the laws of ballistics, those<5μm follow Brownian motion and remain suspended in the air. The aerosols of droplets are very heterogeneous whether the subject is healthy or sick. During an infectious period, not all droplets contain viral RNA. If these RNAs are detectable around patients, on surfaces, and in the ambient air at variable distances according to the studies (from 0.5m to beyond the patient's room), this is without prejudice to the infectious nature (viability) of the virus and the minimum infectious dose. There is a time lag between the patient's infectious period and that of RNA detection for both viruses. Subsequently, the inhaled particles must meet the laws of fluid dynamics (filtration) to settle in the respiratory tree. All of this partly explains the contagiousness and the clinical expression of these two viruses from the olfactory cleft to the alveoli.
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441
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Yung CSY, Fok KCH, Leung CN, Wong YW. What every orthopaedic surgeon should know about COVID-19: A review of the current literature. J Orthop Surg (Hong Kong) 2020; 28:2309499020923499. [PMID: 32406305 DOI: 10.1177/2309499020923499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The coronavirus (COVID-19) pandemic has severely affected the medical community and stopped the world in its tracks. This review aims to provide the basic information necessary for us, orthopaedic surgeons to prepare ourselves to face this pandemic together. Herein, we cover the background of COVID-19, presentation, investigations, transmission, infection control and touch upon emerging treatments. It is of paramount importance that we should stay vigilant for our patients, our families and ourselves. Adequate infection control measures are necessary during day-to-day clinical work.
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Affiliation(s)
- Colin Shing-Yat Yung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kevin Chi Him Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ching Ngai Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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442
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Chan VWS, Chiu PKF, Yee CH, Yuan Y, Ng CF, Teoh JYC. A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions. World J Urol 2020; 39:3127-3138. [PMID: 32462305 PMCID: PMC7251800 DOI: 10.1007/s00345-020-03246-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose and objective We performed a systematic review on COVID-19 and its potential urological manifestations. Methods A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. Results There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30–13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46–100%) amongst them. 5.74% (95% CI 2.88–9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71–83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. Conclusions Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures. Electronic supplementary material The online version of this article (10.1007/s00345-020-03246-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Chi-Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, 4/F LCW Clinical Sciences Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
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443
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Abstract
The COVID-19 outbreak has had a major impact on clinical microbiology laboratories in the past several months. This commentary covers current issues and challenges for the laboratory diagnosis of infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the preanalytical stage, collecting the proper respiratory tract specimen at the right time from the right anatomic site is essential for a prompt and accurate molecular diagnosis of COVID-19. Appropriate measures are required to keep laboratory staff safe while producing reliable test results. The COVID-19 outbreak has had a major impact on clinical microbiology laboratories in the past several months. This commentary covers current issues and challenges for the laboratory diagnosis of infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the preanalytical stage, collecting the proper respiratory tract specimen at the right time from the right anatomic site is essential for a prompt and accurate molecular diagnosis of COVID-19. Appropriate measures are required to keep laboratory staff safe while producing reliable test results. In the analytic stage, real-time reverse transcription-PCR (RT-PCR) assays remain the molecular test of choice for the etiologic diagnosis of SARS-CoV-2 infection while antibody-based techniques are being introduced as supplemental tools. In the postanalytical stage, testing results should be carefully interpreted using both molecular and serological findings. Finally, random-access, integrated devices available at the point of care with scalable capacities will facilitate the rapid and accurate diagnosis and monitoring of SARS-CoV-2 infections and greatly assist in the control of this outbreak.
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444
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Steward JE, Kitley WR, Schmidt CM, Sundaram CP. Urologic Surgery and COVID-19: How the Pandemic Is Changing the Way We Operate. J Endourol 2020; 34:541-549. [PMID: 32336150 DOI: 10.1089/end.2020.0342] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with COVID-19. Adequate personal protective equipment (PPE) for the surgical team is essential to protect health care workers and ensure an adequate workforce. For COVID-19 positive or suspected patients, the use of N95 respirators is recommended if available. The anesthesia method chosen should attempt to minimize aerosolization of the virus. Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures for COVID-19 positive patients or when COVID status is unknown. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra-low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed postoperatively with adequate time allowed for the operating room air to be cycled after procedures. COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.
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Affiliation(s)
- James E Steward
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Weston R Kitley
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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445
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Mustafa Z, Ghaffari M. What Do We Need to Know to Improve Diagnostic Testing Methods for the 2019 Novel Coronavirus? Cureus 2020; 12:e8263. [PMID: 32483515 PMCID: PMC7255081 DOI: 10.7759/cureus.8263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is widespread agreement that reliable, fast, and easy-to-produce diagnostic testing methods that have high sensitivity and specificity are essential for guiding appropriate responses to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. At the present time, there are important unanswered questions about testing methods for SARS-CoV-2. This review article interprets recent findings related to the principal testing methods used to diagnose SARS-CoV-2, including reverse-transcription polymerase chain reaction (RT-PCR), chest imaging, and immunoassay. We discuss the value and limitations of these approaches and suggest directions for future research that can advance the understanding of diagnostic methods. Addressing areas of uncertainty will improve clinical outcomes and allow more effective policies to be implemented to control the disease.
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Affiliation(s)
- Zahid Mustafa
- Internal Medicine, School of Medicine, University of California, Riverside, USA
| | - Masoumeh Ghaffari
- Internal Medicine, School of Medicine, University of California/Riverside Community Hospital, Riverside, USA
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446
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Wang Y, Liao B, Guo Y, Li F, Lei C, Zhang F, Cai W, Hong W, Zeng Y, Qiu S, Wang J, Li Y, Deng X, Li J, Xiao G, Guo F, Lai X, Liang Z, Wen X, Li P, Jiao Q, Xiang F, Wang Y, Ma C, Xie Z, Lin W, Wu Y, Tang X, Li L, Guan Y. Clinical Characteristics of Patients Infected With the Novel 2019 Coronavirus (SARS-Cov-2) in Guangzhou, China. Open Forum Infect Dis 2020; 7:ofaa187. [PMID: 32577426 PMCID: PMC7299522 DOI: 10.1093/ofid/ofaa187] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background The clinical manifestations and factors associated with the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outside of Wuhan are not clearly understood. Methods All laboratory-confirmed cases with SARS-Cov-2 infection who were hospitalized and monitored in Guangzhou Eighth People’s Hospital were recruited from January 20 to February 10. Results A total of 275 patients were included in this study. The median patient age was 49 years, and 63.6% had exposure to Wuhan. The median virus incubation period was 6 days. Fever (70.5%) and dry cough (56.0%) were the most common symptoms. A decreased albumin level was found in 51.3% of patients, lymphopenia in 33.5%, and pneumonia based on chest computed tomography in 86%. Approximately 16% of patients (n = 45) had severe disease, and there were no deaths. Compared with patients with nonsevere disease, those with severe disease were older, had a higher frequency of coexisting conditions and pneumonia, and had a shorter incubation period (all P < .05). There were no differences between patients who likely contacted the virus in Wuhan and those who had no exposure to Wuhan. Multivariate logistic regression analysis indicated that older age, male sex, and decreased albumin level were independently associated with disease severity. Conclusions Most of the patients infected with SARS-CoV-2 in Guangzhou, China are not severe cases and patients with older age, male, and decreased albumin level were more likely to develop into severe ones.
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Affiliation(s)
- Yaping Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Baolin Liao
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yan Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feng Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chunliang Lei
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fuchun Zhang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wenxin Hong
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yu Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shuang Qiu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jian Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yueping Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xilong Deng
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jianping Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guangming Xiao
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fengxia Guo
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xunxi Lai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhiwei Liang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xueliang Wen
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Pinghong Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qian Jiao
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fangfei Xiang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yong Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chenghui Ma
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhiwei Xie
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weiyin Lin
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanrong Wu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoping Tang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yujuan Guan
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
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447
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Voinsky I, Baristaite G, Gurwitz D. Effects of age and sex on recovery from COVID-19: Analysis of 5769 Israeli patients. J Infect 2020; 81:e102-e103. [PMID: 32425274 PMCID: PMC7229949 DOI: 10.1016/j.jinf.2020.05.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Irena Voinsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | - David Gurwitz
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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448
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Dharmarajan H, Snyderman CH. Tracheostomy time-out: New safety tool in the setting of COVID-19. Head Neck 2020; 42:1397-1402. [PMID: 32383532 PMCID: PMC7267311 DOI: 10.1002/hed.26253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission risks when approaching a surgical airway. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time‐out applicable to all patients including those suspected of having COVID‐19. The aim of the tracheostomy time‐out is to reduce preventable errors that may increase the risk of transmission of SARS‐CoV‐2.
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Affiliation(s)
- Harish Dharmarajan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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449
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Kowalik MM, Trzonkowski P, Łasińska-Kowara M, Mital A, Smiatacz T, Jaguszewski M. COVID-19 - Toward a comprehensive understanding of the disease. Cardiol J 2020; 27:99-114. [PMID: 32378729 PMCID: PMC8016030 DOI: 10.5603/cj.a2020.0065] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/07/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
The evidence on the pathophysiology of the novel coronavirus SARS-CoV-2 infection is rapidly growing. Understanding why some patients suffering from COVID-19 are getting so sick, while others are not, has become an informal imperative for researchers and clinicians around the globe. The answer to this question would allow rationalizing the fear surrounding this pandemic. Understanding of the pathophysiology of COVID-19 relies on an understanding of interplaying mechanisms, including SARS-CoV-2 virulence, human immune response, and complex inflammatory reactions with coagulation playing a major role. An interplay with bacterial co-infections, as well as the vascular system and microcirculation affected throughout the body should also be examined. More importantly, a compre-hensive understanding of pathological mechanisms of COVID-19 will increase the efficacy of therapy and decrease mortality. Herewith, presented is the current state of knowledge on COVID-19: beginning from the virus, its transmission, and mechanisms of entry into the human body, through the pathological effects on the cellular level, up to immunological reaction, systemic and organ presentation. Last but not least, currently available and possible future therapeutic and diagnostic options are briefly commented on.
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Affiliation(s)
- Maciej M Kowalik
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
| | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdansk, Dębinki 1, 80-209 Gdańsk, Poland
| | - Magdalena Łasińska-Kowara
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Andrzej Mital
- Department of Hematology and Transplantology, Medical University of Gdansk, Poland
| | | | - Miłosz Jaguszewski
- 1st Department of Cardiology, University Catheterization Laboratories, Medical University of Gdansk, Poland
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450
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Park JS, El-Sayed IH, Young VN, Pletcher SD. Development of clinical care guidelines for faculty and residents in the era of COVID-19. Head Neck 2020; 42:1403-1408. [PMID: 32348581 PMCID: PMC7267355 DOI: 10.1002/hed.26225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 01/11/2023] Open
Abstract
Background The global COVID‐19 pandemic brings new challenges to otolaryngology resident education. Surgical volume and clinic visits are curtailed, personal protective equipment for operating room participation is restricted, and the risk of COVID‐19 disease transmission during heretofore routine patient care is the new norm. Methods We describe a small‐team “cohorting” protocol including guidelines for faculty and resident in common clinical scenarios with attention paid to the risk of common otolaryngologic procedures. Results A rotating small‐team approach was implemented at each clinical site, limiting interaction between department members but providing comprehensive coverage. Faculty were involved at the earliest phase of clinical interactions. Guidelines delineated faculty and resident roles based on risk stratification by patient COVID status and anticipated procedures. Special consideration was given to high‐risk procedures such as endoscopy and tracheotomy. Conclusions A small‐team‐based approach with guidelines for faculty/resident roles may mitigate risk while optimizing patient care and maximizing education.
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Affiliation(s)
- Jason S Park
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA
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