Epidemiological characteristics and initial clinical presentation of patients with laboratory-confirmed MERS-CoV infection in an emergency department

Emergency departments have been implicated as a source of index cases of the Middle East Respiratory Syndrome (MERS) coronavirus infection. We describe the epidemiological characteristics and initial clinical presentation of patients with Middle East respiratory syndrome coronavirus infection in an emergency department at a hospital in Riyadh, in the Kingdom of Saudi Arabia. The records of all patients presenting to the emergency department who tested positive for Middle East respiratory syndrome coronavirus infection on real-time reverse transcriptase polymerase chain reaction testing from April 2014 to November 2019 were reviewed, and the outcomes were assessed. The clinical presentations and outcomes were compared according to sex. A total of 68 patients with Middle East respiratory syndrome coronavirus infection were identified, of whom 40 (58.8%) were female, and 28 (41.2%) were male. The mean age was 50.7 (standard deviation: 16.4) years, and female patients were younger (44.7±13.1 years) than male patients (59.4 ± 16.9 years). Nineteen of the 68 patients (27.9%) were asymptomatic of whom the majority (16/19, 84%) were female (p = 0.012). The most common symptoms were fever (n = 29, 42.6%), cough (n = 25, 36.8%), upper respiratory tract infection (n = 23, 33.8%), and pneumonia (n = 15, 22.1%). Pneumonia, diarrhea, dyspnea, and vomiting/diarrhea were more common among male patients. Male patients were more likely than female patients to require hospital admission (78.6% vs. 30.0%), intensive care unit admission (64.3% vs. 15.0%), and invasive mechanical ventilation (32.1% vs. 10.0%). The most common presentation of Middle East respiratory syndrome coronavirus infection in this cohort was asymptomatic infection. A high proportion of asymptomatic infections has not been reported previously. The study did not identify typical clinical features of MERS patients. Male patients tended to develop more severe disease than female patients. A larger study is needed to confirm these findings. © 2022 The Author(s). Published by MRE Press.

Radiologic Findings of COVID-19 Associated Mucormycosis (CAM) from India

Background. The unique feature of the second wave of the COVID -19 pandemic in India has been the alarming surge of acute invasive fungal infection among COVID -19 patients. The increased incidence of rhino-orbito-cerebral mucormycosis is a matter of concern, as this fulminant infection has high morbidity and mortality. Hence, it is imperative to understand it's imaging features, for early diagnosis, staging and treatment. Methods. We systematically reviewed 32 COVID-19 cases with imaging diagnosis of acute invasive fungal rhino-sinusitis or rhino-orbital-cerebral disease between March to May 2021. These patients underwent contrast MRI of the paranasal sinus, orbit and brain. Contrast enhanced CT chest and paranasal sinuses were done as needed. Results. The age group ranged between 30 to 71 yrs with male preponderance. The most common predisposing factors were intravenous steroid therapy and supplemental oxygen. All cases were confirmed by fungal culture and most common was Mucor. The rhino-orbito-cerebral mucormycosis was staged as below In our study we found that the most common site in the nasal cavity was the middle turbinate /meatus and the earliest sign was non-enhancing / "black" turbinate. Premaxillary and retroantral fat necrosis was the earliest sign of soft tissue invasion. Spread via the sphenopalatine foramen and pterygopalatine fossa was more common than bony erosions. Orbital cellulitis and optic neuritis were the most common among stage 3 cases. Of patients with CNS involvement, the most common were cavernous sinus thrombosis and trigeminal neuritis. Two patients with pulmonary mucormycosis showed large necrotic cavitary lesions, giving the characteristic "bird's nest" appearance. Conclusion. The mortality rate was 20% in our study. In our short term follow up, 30 % of recovered patients had relapse on imaging due to incomplete clearance and partial antifungal treatment. High clinical suspicion and low imaging threshold are vital for early Mucormycosis detection in COVID-19 patients. Familiarity with early imaging signs is critical to prevent associated morbidity /mortality. Axial CT chest image in lung window shows necrotic right upper lobe cavity with internal septations and debris on a background of surrounding COVID-19 changes.

Coronavirus Disease Mortality: Understanding Regional Differences

Since the emergence of the coronavirus disease (COVID-19) pandemic, the world has struggled to contain it and deal with the in-creasing number of deaths. There have been reported variations in the incidence, prevalence, and fatality rates. These variations were thought to be multifactorial rather than due solely to unique characteristics or interventions. This work reviews data publicly available regarding COVID-19 and discusses the possible reasons for the regional variabilities of prevalence and mortality.

Modulation of host epigenome by coronavirus infections and developing treatment modalities for COVID-19 beyond genetics.

The recent Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak has resulted in coronavirus disease 2019 (COVID-19) pandemic worldwide, affecting millions of lives. Although vaccines are presently made available, and vaccination drive is in progress to immunize a larger population; still the risk of SARS-CoV-2 infection and related mortality is persistent amid threats of the third wave of the ongoing pandemic. In the scenario of unavailability of robust and efficient treatment modalities, it becomes essential to understand the mechanism of action of the virus and deeply study the molecular mechanisms (both at the virus level and the host level) underlying the infection processes. Recent studies have shown that coronaviruses (CoVs) cause-specific epigenetic changes in the host cells to create a conducive microenvironment for replicating, assembling, and spreading. Epigenetic mechanisms can contribute to various aspects of the SARS-CoV-2 multiplication cycle, like expressing cytokine genes, viral receptor ACE2, and implicating different histone modifications. For SARS-CoV-2 infection, viral proteins are physically associated with various host proteins resulting in numerous interactions between epigenetic enzymes (i.e., histone deacetylases, bromodomain-containing proteins). The involvement of epigenetic mechanisms in the virus life cycle and the host immune responses to control infection result in epigenetic factors recognized as emerging prognostic COVID-19 biomarkers and epigenetic modulators as robust therapeutic targets to curb COVID-19. Therefore, this narrative review aimed to summarize and discuss the various epigenetic mechanisms that control gene expression and how these mechanisms are altered in the host cells during coronavirus infection. We also discuss the opportunities to exploit these epigenetic changes as therapeutic targets for SARS-CoV-2 infection. Epigenetic alterations and regulation play a pivotal role at various levels of coronavirus infection: entry, replication/transcription, and the process of maturation of viral proteins. Coronaviruses modulate the host epigenome to escape the host immune mechanisms. Therefore, host epigenetic alterations induced by CoVs can be considered to develop targeted therapies for COVID-19.

Airborne transmission of SARS-CoV-2 is the dominant route of transmission: droplets and aerosols

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic worldwide. On a daily basis the number of deaths associated with COVID-19 is rapidly increasing. The main transmission route of SARS-CoV-2 is through the air (airborne transmission). This review details the airborne transmission of SARS-CoV-2, the aerodynamics, and different modes of transmission (e.g. droplets, droplet nuclei, and aerosol particles). SARS-CoV-2 can be transmitted by an infected person during activities such as expiration, coughing, sneezing, and talking. During such activities and some medical procedures, aerosols and droplets contaminated with SARS-CoV-2 particles are formed. Depending on their sizes and the environmental conditions, such particles stay viable in the air for varying time periods and can cause infection in a susceptible host. Very few studies have been conducted to establish the mechanism or the aerodynamics of virus-loaded particles and droplets in causing infection. In this review we discuss the various forms in which SARS-CoV-2 virus particles can be transmitted in air and cause infections.