ABSTRACT
Background The clinical course of pneumonia caused by SARS-CoV-2 is quite peculiar and is characterized by a rapid deterioration of the clinical condition of patients. The aim of this study is to characterize immunological dysfunctions in COVID-19 patients and correlate them with markers of hyperactivation of the inflammatory response, in an attempt to find threshold values indicative of patient outcome. Methods A total of 100 patients were recruited. All patients had a positive PCR test for SARS-COV-2 from nasopharyngeal sample. Patients were grouped into those who did not require mechanical ventilation (n=72) and those who required mechanical ventilation (n=28). Blood samples were collected and analyzed at the point of admission in all patients. Patient immune phenotyping was performed in whole blood samples of patients by flow cytometric analysis. The flow cytometric analysis was performed in an Aquios cytometer (Aquios -Beckman Coulter CA, USA). Antibodies used for cell staining are TETRA-1 Panel (CD45, CD4, CD8, CD3). Data were analyzed using flow cytometric analysis software. Data from the routine biochemical assessment performed in the first 24 hrs after admission to infectious diseases unit will be collected. Results Both the percentage and the absolute number of neutrophils were higher in patients needing ICU care than non-ICU patients, whereas absolute lymphocyte count, and especially the percentage of lymphocytes, presented a deep decline in critical patients. There was no difference between the two groups of patients for CD4 Tlymphocytes, neither in percentage of lymphocyte nor in absolute number, however for CD8 T-cells the differences were significant for both parameters which were in decline in ICU patients. There was a firm correlation between the highest values of inflammation indicators with the decrease in percentage of CD8 T-lymphocytes. This effect was not seen with CD4 cells. Conclusion Our results describe the immune response of severe COVID-19 patients and highlight the value of a novel ratio of CD4/CD8 as a putative marker of poor prognosis. Nevertheless, further research is warranted in order to fully comprehend the transition of the different stages of COVID-19 progression in the context of successful combat of this novel disease.
ABSTRACT
Background and Aim: As of 22 June 2020, Italy had 238.499cases of Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) infections, with about 35.000 deaths. A single-center observational cohort study was conducted to evaluate epidemiological, demographic, clinical and laboratory data of SARS-CoV-2patients who were admitted to the sub-intensive therapy unit ofthe COVID Unit Hospital F. Miulli (Acquaviva delle Fonti, Bari, Italy),from Mar 17, 2020 to May 17, 2020.Materials and Methods: Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes wereall collected and analysed. Results: A total of 143 SARS-CoV-2 patients, 60.4% males, meanage 68 yrs , were included. Twenty-seven patients (19%) had clinical signs of severe pneumonia and 6.3% had an ARDS, ICU admissions were 2.9%. The most represented comorbidities were:chronic heart failure (10.3%), diabetes (15.5%), chronic obstructive pulmonary disease (17.8%), cancer (13.2%), kidney chronicfailure (28.2%). The used drugs have been distributed as follows:lopinavir/ritonavir (30.4%), hydroxychloroquine (67.8%), steroid(21.2%), tocilizumab (4%). Length of stay was 21 days and theaverage negative time of the second nasopharyngeal swab was18 days. In our study, a total of 20 patients (13.9%) died, withmean age 86 yrs .Conclusions: Our findings show that SARS-CoV-2 infection maybe severe, requiring intensive care admission, expecially in olderpatients and in those with comorbidities.
ABSTRACT
The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.