Saliva Quantification of SARS-CoV-2 in Real-Time PCR From Asymptomatic or Mild COVID-19 Adults.

The fast spread of COVID-19 is related to the highly infectious nature of SARS-CoV-2. The disease is suggested to be transmitted through saliva droplets and nasal discharge. The saliva quantification of SARS-CoV-2 in real-time PCR from asymptomatic or mild COVID-19 adults has not been fully documented. This study analyzed the relationship between salivary viral load on demographics and clinical characteristics including symptoms, co-morbidities in 160 adults diagnosed as COVID-19 positive patients recruited between September and December 2020 in four French centers. Median initial viral load was 4.12 log10 copies/mL (IQR 2.95-5.16; range 0-10.19 log10 copies/mL). 68.6% of adults had no viral load detected. A median load reduction of 23% was observed between 0-2 days and 3-5 days, and of 11% between 3-5 days and 6-9 days for the delay from onset of symptoms to saliva sampling. No significant median difference between no-symptoms vs. symptoms patients was observed. Charge was consistently similar for the majority of the clinical symptoms excepted for headache with a median load value of 3.78 log10 copies/mL [1.95-4.58] (P < 0.003). SARS-CoV-2 RNA viral load was associated with headache and gastro-intestinal symptoms. The study found no statistically significant difference in viral loads between age groups, sex, or presence de co-morbidity. Our data suggest that oral cavity is an important site for SARS-CoV-2 infection and implicate saliva as a potential route of SARS-CoV-2 transmission.

Use of an antiviral mouthwash as a barrier measure in the SARS-CoV-2 transmission in adults with asymptomatic to mild COVID-19: a multicentre, randomized, double-blind controlled trial.

OBJECTIVES: To determine if commercially available mouthwash with ß-cyclodextrin and citrox (bioflavonoids) (CDCM) could decrease the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary viral load. METHODS: In this randomized controlled trial, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive patients aged 18-85 years with asymptomatic to mild coronavirus disease 2019 (COVID-19) symptoms for <8 days were recruited. A total of 176 eligible patients were randomly assigned (1:1) to CDCM or placebo. Three rinses daily were performed for 7 days. Saliva sampling was performed on day 1 at 09.00 (T1), 13.00 (T2) and 18.00 (T3). On the following 6 days, one sample was taken at 15.00. Quantitative RT-PCR was used to detect SARS-CoV-2. RESULTS: The intention-to-treat analysis demonstrated that, over the course of 1 day, CDCM was significantly more effective than placebo 4 hours after the first dose (p 0.036), with a median percentage (log10 copies/mL) decrease T1-T2 of -12.58% (IQR -29.55% to -0.16%). The second dose maintained the low median value for the CDCM (3.08 log10 copies/mL; IQR 0-4.19), compared with placebo (3.31 log10 copies/mL; IQR 1.18-4.75). At day 7, there was still a greater median percentage (log10 copies/mL) decrease in salivary viral load over time in the CDCM group (-58.62%; IQR -100% to -34.36%) compared with the placebo group (-50.62%; IQR -100% to -27.66%). These results were confirmed by the per-protocol analysis. CONCLUSIONS: This trial supports the relevance of using CDCM on day 1 (4 hours after the initial dose) to reduce the SARS-CoV-2 viral load in saliva. For long-term effect (7 days), CDMC appears to provide a modest benefit compared with placebo in reducing viral load in saliva.

Habitual Hyperthermia: An Interpretive Paradigm of the 20th Century? Not Really.

Prolonged and unexplained fevers in young adults are uncommon, especially when access to diagnostic tests is simplified. Therefore, the definition of unexplained fever depends on the volume of tests performed. However, low-grade fever has not been a priority in research. Management of low-grade fever [eg, an oral temperature of ≥37.8°C (100°F) and <38.3°C (101°F) at any time of the day] is not codified. The presented case of a 37-year-old nurse with an intermittent fever for three months, with no clear diagnostic evidence and no elevated markers of inflammation, illustrates "habitual hyperthermia" (HH)-retained after ordering tests sequentially in town and at the hospital. HH was made known by Prof. H.A. Reimann (1897-1986) an American virologist, although the diagnostic criteria are fallible. The article reviews the criteria and then discusses how to select diagnostic tests in family practice for prolonged fever in young adults without clinical signs of orientation. Given the polymorphism of febrile illnesses, the principle of parsimony must be transgressed, and in the event of an early suspicion of HH, surveillance is a rule to be further amended.

Femoral Arterial Thrombosis in a Young Adult after Nonsevere COVID-19.

INTRODUCTION: Few cases of arterial thromboembolisms have been reported after novel coronavirus disease 2019 (COVID-19) in case of severe infection or in elderly patients. We report a case of femoral arterial thrombosis in a young patient after nonsevere infection. CASE DESCRIPTION: A common femoral artery thrombosis extended in the first third of superficial and profunda femoral arteries associated with tibial posterior and popliteal artery thrombosis was diagnosed in a 24-year-old man complaining of right lower limb pain for one month. The evolution was good after anticoagulation and antiaggregant treatments and thrombectomy. Etiologic assessment was negative except for nonsevere COVID-19. DISCUSSION: COVID-19 accesses host cells via angiotensin-converting enzyme 2 protein, abundant in the lungs, which is also expressed by endothelial cells and is associated with important inflammatory syndrome and coagulopathy, leading to vascular lesions. Thrombosis prevalence is not fully established and seems to be higher in case of major inflammation and in the intensive care unit (ICU). Arterial thromboembolisms are described in many vascular territories, each time in elderly patients, or in case of severe infection. We described a femoral arterial thrombosis in a young patient with negative etiological assessment except nonsevere COVID-19. Treatment consists in anticoagulation and antiaggregant drugs and thrombectomy. Preventing venous thromboembolism treatment is recommended in case of severe infection or in the ICU, but there is no clear recommendation for arterial thromboembolism prevention. This case should lead us to be very careful of the arterial event risk even if the infection is nonsevere and the patient is young.