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Kato H, Shimizu H, Shibue Y, Hosoda T, Iwabuchi K, Nagamine K, Saito H, Sawada R, Oishi T, Tsukiji J, Fujita H, Furuya R, Masuda M, Akasaka O, Ikeda Y, Sakamoto M, Sakai K, Uchiyama M, Watanabe H, Yamaguchi N, Higa R, Sasaki A, Tanaka K, Toyoda Y, Hamanaka S, Miyazawa N, Shimizu A, Fukase F, Iwai S, Komase Y, Kawasaki T, Nagata I, Nakayama Y, Takei T, Kimura K, Kunisaki R, Kudo M, Takeuchi I, Nakajima H. Clinical course of 2019 novel coronavirus disease (COVID-19) in individuals present during the outbreak on the Diamond Princess cruise ship. J Infect Chemother 2020; 26:865-869. [PMID: 32405245 PMCID: PMC7218347 DOI: 10.1016/j.jiac.2020.05.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023]
Abstract
We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.
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Affiliation(s)
- Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Japan; Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan.
| | - Hiroyuki Shimizu
- Department of Clinical Laboratory Medicine, Fujisawa City Hospital, Japan
| | - Yasushi Shibue
- Department of Infectious Diseases, Yokohama City Minato Red Cross Hospital, Japan
| | - Tomohiro Hosoda
- Department of Infectious Diseases, Kawasaki Municipal Kawasaki Hospital, Japan
| | - Keisuke Iwabuchi
- Department of General Medicine, Kanagawa Prefectural Ashigarakami Hospital, Japan
| | | | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Japan
| | - Reimin Sawada
- Department of Cardiology, Japanese Red Cross Hadano Hospital, Japan
| | - Takayuki Oishi
- Department of Infection Control and Prevention, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Jun Tsukiji
- Department of Prevention and Infection Control, Yokohama City University Medical Center, Japan
| | - Hiroyuki Fujita
- Infection Control Committee, Saiseikai Yokohama Nanbu Hospital, Japan
| | - Ryosuke Furuya
- Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Japan
| | - Makoto Masuda
- Department of Respiratory Medicine, Fujisawa City Hospital, Japan
| | - Osamu Akasaka
- Emergency Medical Center, Fujisawa City Hospital, Japan
| | - Yu Ikeda
- Emergency Medical Center, Fujisawa City Hospital, Japan
| | - Mitsuo Sakamoto
- Department of Infectious Diseases, Kawasaki Municipal Kawasaki Hospital, Japan
| | - Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University School of Medicine, Japan
| | - Munehito Uchiyama
- Department of Emergency Medicine, Yokohama City University School of Medicine, Japan
| | - Hiroki Watanabe
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan
| | | | - Ryoko Higa
- Department of Prevention and Infection Control, Yokohama City University Medical Center, Japan
| | - Akiko Sasaki
- Nursing Department, Japanese Red Cross Hadano Hospital, Japan
| | - Katsuaki Tanaka
- Department of Gastroenterology, Japanese Red Cross Hadano Hospital, Japan
| | - Yukitoshi Toyoda
- Department of Emergency and Critical Care Medicine Major Trauma Center Trauma & Acute Care Surgery, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Shinsuke Hamanaka
- Department of Pulmonary Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Naoki Miyazawa
- Department of Respiratory Medicine, Saiseikai Yokohama Nanbu Hospital, Japan
| | - Atsuko Shimizu
- Infection Control Team, National Yokohama Medical Center, Japan
| | - Fumie Fukase
- Infection Control Team, National Yokohama Medical Center, Japan
| | - Shunsuke Iwai
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Japan
| | - Yuko Komase
- Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Japan
| | - Tsutomu Kawasaki
- Department of Respiratory Medicine, Yokohama City Minato Red Cross Hospital, Japan
| | - Isao Nagata
- Intensive Care Unit, Yokohama City Minato Red Cross Hospital, Japan
| | - Yusuke Nakayama
- Emergency Department, Yokohama City Minato Red Cross Hospital, Japan
| | - Tetsuhiro Takei
- Intensive Care Unit, Yokohama City Minato Red Cross Hospital, Japan
| | - Katsuo Kimura
- Department of Neurology, Yokohama City University Medical Center, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
| | - Makoto Kudo
- Respiratory Disease Center, Yokohama City University Medical Center, Japan
| | - Ichiro Takeuchi
- Kanagawa Disaster Medical Assistance Team, Japan; Advanced Emergency Medical Service Center, Yokohama City University Medical Center, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
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Kato H, Ide K, Fukase F, Shimura Y, Yasuda S, Goto H, Fukuyama A, Nakajima H. Polymerase chain reaction-based open reading frame typing (POT) method analysis for a methicillin-resistant Staphylococcus aureus (MRSA) outbreak through breast-feeding in the neonatal intensive care unit. IDCases 2018; 12:1-3. [PMID: 29942739 PMCID: PMC6010953 DOI: 10.1016/j.idcr.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction The route of methicillin-resistant Staphylococcus aureus (MRSA) transmission in the neonatal intensive care unit (NICU) is not clearly explained. We investigate an MRSA outbreak involving five babies in the NICU. The molecular investigation using polymerase chain reaction-based open reading frame typing (POT) method was performed. Presentation of outbreak A MRSA outbreak occurred in a six-bed NICU affecting 5 babies. Within 13 days of the emergence of index case, all five babies including triplets and other two babies were found to colonize MRSA by the active surveillance culture. Environmental surveillance cultures revealed that the preserved breast milk provided by the triplets' mother was the only item in the NICU that was positive for MRSA. The mother had a bite wound on the nipples, and the breast milk was not pasteurized. The POT method revealed that MRSA strains detected from the triplets, the breast milk, and the other baby who was fed the triplets' mother's milk were genetically identical (POT index: 106-247-33). The all strains of MRSA carried Staphylococcal cassette chromosome mec (SCCmec) IV and had good susceptibility for the non-ß-lactam antimicrobial agents, suggesting the strains were community-acquired MRSA. Conclusions The mother’s milk contaminated with community-origin MRSA is serving as the reservoir of MRSA and one of the sources of MRSA outbreaks in the NICU. It is important to closely monitor the condition of the mothers of the children in the NICU. Pasteurization of breast milk should be considered when the skin on the nipple is broken.
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Affiliation(s)
- Hideaki Kato
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan.,Infection Prevention and Control Department, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kazuo Ide
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Fumie Fukase
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Yukihiro Shimura
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Shuhei Yasuda
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Hideto Goto
- Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Ayako Fukuyama
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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