Patients of COVID-19 may benefit from sustained Lopinavir-combined regimen and the increase of Eosinophil may predict the outcome of COVID-19 progression.
Liu Fang,Xu Aifang,Zhang Yan,Xuan Weiling,Yan Tingbo,Pan Kenv,Yu Wenyan,Zhang Jun
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
OBJECTIVES:To explore the epidemiological information, clinical characteristics, therapeutic outcomes and temporal progression of laboratory findings in 2019-coronavirus disease (COVID-19) patients exposed to lopinavir. METHODS:We collected data from ten COVID-19 patients admitted between January 22, 2020 and February 11, 2020 at Xixi hospital in Hangzhou, China. RESULTS:Of ten patients, secondary, tertiary and quartus patients emerged; the incubation period was 3-7 days. Mainly initial symptoms were cough and low fever (37.3-38.0°C). An asymptomatic case presented normal radiography, the others had ground glass opacities. All cases (three transferred, seven discharged) were exposed to lopinavir on initial hospitalization. Three patients stopped lopinavir because of adverse effects, two of them deteriorated, one was hospitalized longer than others who with sustained lopinavir use. Levels of potassium, albumin, and lymphocytes were low, but increased persistently after treatment. Eosinophil values were low on initial hospitalization, then all returned to normal before discharge. Viral load of SARS-CoV-2, radiography and eosinophil improved continuously in 3-14, 6-8 and 7-9 days, respectively. CONCLUSIONS:Increasing eosinophils may be an indicator of COVID-19 improvement. The COVID-19 patients may benefit from sustained lopinavir use. More research on a larger scale is needed to verify these points.
Nucleic acid amplification-based diagnosis of respiratory virus infections.
Mahony James B
Expert review of anti-infective therapy
The appearance of eight new respiratory viruses in the human population in the past 9 years, including two new pandemics (SARS coronavirus in 2003 and swine-origin influenza A/H1N1 in 2009), has tested the ability of virology laboratories to develop diagnostic tests to identify these viruses. Nucleic acid amplification tests (NATs) that first appeared two decades ago have been developed for both conventional and emerging viruses and now form the backbone of the clinical laboratory. NATs provide fast, accurate and sensitive detection of respiratory viruses and have significantly increased our understanding of the epidemiology of these viruses. Multiplex PCR assays have been introduced recently and several commercial tests are now available. The final chapter in the evolution of respiratory virus diagnostics will be the addition of allelic discrimination and detection of single nucleotide polymorphisms associated with antiviral resistance to multiplex assays. These resistance assays together with new viral load tests will enable clinical laboratories to provide physicians with important information for optimal treatment of patients.
Distinguishing characteristics between pandemic 2009-2010 influenza A (H1N1) and other viruses in patients hospitalized with respiratory illness.
Chan Philip A,Mermel Leonard A,Andrea Sarah B,McCulloh Russell,Mills John P,Echenique Ignacio,Leveen Emily,Rybak Natasha,Cunha Cheston,Machan Jason T,Healey Terrance T,Chapin Kimberle C
BACKGROUND:Differences in clinical presentation and outcomes among patients infected with pandemic 2009 influenza A H1N1 (pH1N1) compared to other respiratory viruses have not been fully elucidated. METHODOLOGY/PRINCIPAL FINDINGS:A retrospective study was performed of all hospitalized patients at the peak of the pH1N1 season in whom a single respiratory virus was detected by a molecular assay targeting 18 viruses/subtypes (RVP, Luminex xTAG). Fifty-two percent (615/1192) of patients from October, 2009 to December, 2009 had a single respiratory virus (291 pH1N1; 207 rhinovirus; 45 RSV A/B; 37 parainfluenza; 27 adenovirus; 6 coronavirus; and 2 metapneumovirus). No seasonal influenza A or B was detected. Individuals with pH1N1, compared to other viruses, were more likely to present with fever (92% & 70%), cough (92% & 86%), sore throat (32% & 16%), nausea (31% & 8%), vomiting (39% & 30%), abdominal pain (14% & 7%), and a lower white blood count (8,500/L & 13,600/L, all p-values<0.05). In patients with cough and gastrointestinal complaints, the presence of subjective fever/chills independently raised the likelihood of pH1N1 (OR 10). Fifty-five percent (336/615) of our cohort received antibacterial agents, 63% (385/615) received oseltamivir, and 41% (252/615) received steroids. The mortality rate of our cohort was 1% (7/615) and was higher in individuals with pH1N1 compared to other viruses (2.1% & 0.3%, respectively; p = 0.04). CONCLUSIONS/SIGNIFICANCE:During the peak pandemic 2009-2010 influenza season in Rhode Island, nearly half of patients admitted with influenza-like symptoms had respiratory viruses other than influenza A. A high proportion of patients were treated with antibiotics and pH1N1 infection had higher mortality compared to other respiratory viruses.
Influenza in Children.
Indian journal of pediatrics
In children, influenza is one among the commonest causes of acute respiratory illness and loss of school days. Influenza A, B, and C are 3 types of viruses responsible for illness. Type A virus has many subtypes based on antigens but Type B and Type C viruses have no known subtypes. Currently, influenza A/H1N1, A/H3N2, and influenza type B viruses are circulating in humans. Transmission of influenza occurs through droplets from infected person or through direct contact with person or fomites. Clinically, influenza is characterized by acute onset fever, chills, running nose, cough, sore throat, headache and myalgia. Mostly, febrile illness lasts for 3-4 d with resolution of disease in 7-10 d. Confirmation of influenza can be done either by virus culture, RT-PCR or specific neutralizing antibodies in blood. Basic principles of management include prompt institution of infection control measures, early identification of children at higher risk, supportive care and antiviral drugs. Vaccine and chemoprophylaxis are two commonly used methods for prevention of influenza. Currently, inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are available for use with good efficacy. Cough etiquette, use of face masks and hand hygiene are the most important measures to reduce the risk of infection transmission from person to person.
Decreased mitochondrial DNA copy number in children with cerebral palsy quantified by droplet digital PCR.
Lu Bichao,Zeng Fanyong,Xing Wen,Liang Lin,Huo Jianbo,Tan Chianru,Zhu Lingxiang,Liu Zhizhong
Clinica chimica acta; international journal of clinical chemistry
BACKGROUND:Mitochondrial DNA copy number is a potential biomarker for mitochondrial dysfunction and is involved in a variety of disease states including autism, neurodegenerative diseases and traumatic brain injury, but few studies on mitochondrial DNA copy number in cerebral palsy have been reported. Therefore, this study aims to investigate the role of mitochondrial DNA copy number in children with cerebral palsy. METHODS:A total of 104 children with cerebral palsy and 78 typically developing children were enrolled in this study. All children with cerebral palsy were diagnosed according to clinical criteria and furtherly divided into clinical subtypes. Mitochondrial DNA copy number was quantified by droplet digital PCR. RESULTS:We observed a significant reduction in mitochondrial DNA copy number from children with cerebral palsy comparing to healthy controls (216.76 ± 71.39 vs 359.66 ± 72.78, p < 0.001). An upward trend in mitochondrial DNA copy number alteration with the increase of age was found in healthy controls rather than in children with cerebral palsy. In addition, the mitochondrial DNA copy number in children with spastic hemiplegia was higher than that in children with spastic quadriplegia (152.27 ± 49.78 vs 90.64 ± 21.55, p = 0.001). CONCLUSIONS:Our results suggest that on the basis of accurate quantification by droplet digital PCR, the declined mitochondrial DNA copy number probably has certain implications for mitochondrial dysfunction in children with cerebral palsy, which provides a new clue for the investigation on the molecular mechanism and clinical characteristics of cerebral palsy.
Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes.
Zhang Wei,Du Rong-Hui,Li Bei,Zheng Xiao-Shuang,Yang Xing-Lou,Hu Ben,Wang Yan-Yi,Xiao Geng-Fu,Yan Bing,Shi Zheng-Li,Zhou Peng
Emerging microbes & infections
In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
Rise of the Rxivs: How Preprint Servers are Changing the Publishing Process.
Hoy Matthew B
Medical reference services quarterly
Scientific publishing is a complex and time-consuming process. Submitting an article to a journal, waiting for review, and revising can take months or even years. Authors can speed up parts of this process by posting early versions their articles online to gather feedback and improve them prior to submission to a journal. These early versions are referred to as "preprints." Preprints have been common practice in some disciplines for decades, but are a relatively new phenomenon in biology and medicine. This column will provide a brief history of article preprints and their use in different scientific disciplines. It will also discuss the advantages of and problems with preprints. A list of popular preprint servers is also included.
Understanding of COVID-19 based on current evidence.
Sun Pengfei,Lu Xiaosheng,Xu Chao,Sun Wenjuan,Pan Bo
Journal of medical virology
Since December 2019, a series of unexplained pneumonia cases have been reported in Wuhan, China. On 12 January 2020, the World Health Organization (WHO) temporarily named this new virus as the 2019 novel coronavirus (2019-nCoV). On 11 February 2020, the WHO officially named the disease caused by the 2019-nCoV as coronavirus disease (COVID-19). The COVID-19 epidemic is spreading all over the world, especially in China. Based on the published evidence, we systematically discuss the characteristics of COVID-19 in the hope of providing a reference for future studies and help for the prevention and control of the COVID-19 epidemic.
Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity.
Chen Weilie,Lan Yun,Yuan Xiaozhen,Deng Xilong,Li Yueping,Cai Xiaoli,Li Liya,He Ruiying,Tan Yizhou,Deng Xizi,Gao Ming,Tang Guofang,Zhao Lingzhai,Wang Jinlin,Fan Qinghong,Wen Chunyan,Tong Yuwei,Tang Yangbo,Hu Fengyu,Li Feng,Tang Xiaoping
Emerging microbes & infections
The novel coronavirus (2019-nCoV) infection caused pneumonia. we retrospectively analyzed the virus presence in the pharyngeal swab, blood, and the anal swab detected by real-time PCR in the clinical lab. Unexpectedly, the 2109-nCoV RNA was readily detected in the blood (6 of 57 patients) and the anal swabs (11 of 28 patients). Importantly, all of the 6 patients with detectable viral RNA in the blood cohort progressed to severe symptom stage, indicating a strong correlation of serum viral RNA with the disease severity (-value = 0.0001). Meanwhile, 8 of the 11 patients with annal swab virus-positive was in severe clinical stage. However, the concentration of viral RNA in the anal swab (Ct value = 24 + 39) was higher than in the blood (Ct value = 34 + 39) from patient 2, suggesting that the virus might replicate in the digestive tract. Altogether, our results confirmed the presence of virus RNA in extra-pulmonary sites.
Potential Rapid Diagnostics, Vaccine and Therapeutics for 2019 Novel Coronavirus (2019-nCoV): A Systematic Review.
Pang Junxiong,Wang Min Xian,Ang Ian Yi Han,Tan Sharon Hui Xuan,Lewis Ruth Frances,Chen Jacinta I-Pei,Gutierrez Ramona A,Gwee Sylvia Xiao Wei,Chua Pearleen Ee Yong,Yang Qian,Ng Xian Yi,Yap Rowena Ks,Tan Hao Yi,Teo Yik Ying,Tan Chorh Chuan,Cook Alex R,Yap Jason Chin-Huat,Hsu Li Yang
Journal of clinical medicine
Rapid diagnostics, vaccines and therapeutics are important interventions for the management of the 2019 novel coronavirus (2019-nCoV) outbreak. It is timely to systematically review the potential of these interventions, including those for Middle East respiratory syndrome-Coronavirus (MERS-CoV) and severe acute respiratory syndrome (SARS)-CoV, to guide policymakers globally on their prioritization of resources for research and development. A systematic search was carried out in three major electronic databases (PubMed, Embase and Cochrane Library) to identify published studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Supplementary strategies through Google Search and personal communications were used. A total of 27 studies fulfilled the criteria for review. Several laboratory protocols for confirmation of suspected 2019-nCoV cases using real-time reverse transcription polymerase chain reaction (RT-PCR) have been published. A commercial RT-PCR kit developed by the Beijing Genomic Institute is currently widely used in China and likely in Asia. However, serological assays as well as point-of-care testing kits have not been developed but are likely in the near future. Several vaccine candidates are in the pipeline. The likely earliest Phase 1 vaccine trial is a synthetic DNA-based candidate. A number of novel compounds as well as therapeutics licensed for other conditions appear to have in vitro efficacy against the 2019-nCoV. Some are being tested in clinical trials against MERS-CoV and SARS-CoV, while others have been listed for clinical trials against 2019-nCoV. However, there are currently no effective specific antivirals or drug combinations supported by high-level evidence.