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Wastewater-based epidemiology (WBE) targeting SARS-CoV-2 RNA detection in municipal wastewater is considered a valuable tool for COVID-19 surveillance in a community. However, the persistence and removal of SARS-CoV-2 RNA in wastewater treatment plants (WWTPs) have not been well investigated. This study is aimed at detecting SARS-CoV-2 RNA in wastewater to correlate viral concentrations with clinical COVID-19 cases in the sewershed and determine whether the SARS-CoV-2 genetic material is detectable after treatment. Raw influent, primary effluent (after primary clarification), secondary effluent (after activated sludge treatment), and final effluent (after chlorination) samples were collected two times a week from the largest WWTP in San Antonio (Texas) during April to November 2021 and analyzed for SARS-CoV-2 RNA (N1 and N2 genes) concentrations using the reverse transcription droplet digital polymerase chain reaction (RT-ddPCR). SARS-CoV-2 RNA was detected in 98.5% (n = 34 weeks) of the raw influent samples and anticipated the trends of the COVID-19 outbreak. Furthermore, a higher correlation between viral concentrations and COVID-19 cases was observed for two days a week sampling frequency (ρ = 0.75, p <0.001) than one day per week (ρ = 0.60, p <0.001). Despite the high SARS-CoV-2 RNA concentrations in raw sewage, a significant amount of viral RNA was removed at primary and secondary clarifiers (removal efficiencies were 54% and 94%, respectively) and was undetectable in final effluents. These results demonstrate the performance of the WWTP in reducing the SARS-CoV-2 RNA concentration and further highlight the role of tertiary treatment and chlorination in eliminating SARS-CoV-2 RNA in receiving waters. © 2023 RSC.
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Introduction: Acute interstitial pneumonia (AIP) also known as Hamman-Rich Syndrome is an uncommon, acute, and rapidly progressive idiopathic pulmonary disease that often leads to acute respiratory distress syndrome (ARDS). We present a case of a 52-year-old male who developed this condition. Case: A 52-year-old male with no past medical history presented to the emergency department with a 3-day history of progressively worsening dyspnea, dry cough, and chills. Prior to symptom onset, he was in his usual state of health but did report having polyarthralgia mainly involving large joints with no other associated symptoms. He denied a history of sick contacts including COVID exposure, sexually transmitted infections, incarceration, intravenous drug abuse, or travel to tuberculosis endemic countries. He denied tobacco use and any other form of illicit drug use. On physical examination, he was afebrile, tachycardic, and hypoxic on room air. He appeared to be in no respiratory distress and chest was clear to auscultation. There were no joint abnormalities, skin rashes, or lymphadenopathy. Lab workup revealed elevated D-Dimer (2140 ng/mL), CRP (50 mg/L), lactate dehydrogenase (296 IU/L), ferritin (578 ng/mL). His SARSCoV2 PCR was negative. Chest X-ray and CT chest both revealed right pleural effusion and diffuse reticular and ground-glass opacities. He underwent thoracentesis and fluid analysis revealed lymphocytic exudate with negative cultures. Antibiotics and steroids were initiated. He underwent a complete rheumatologic workup including myositis panel, due to concern for possible autoimmune etiologies and it was negative. His respiratory status worsened, and he eventually required intubation. At this point given unclear etiology, he underwent bronchoscopy with transbronchial cryobiopsy. Cryobiopsy revealed evidence of organizing phase of diffuse alveolar damage (Figure 1) and in the setting of negative cultures, COVID-19 and autoimmune panel, there was a growing concern for acute interstitial pneumonia. The patient was started on pulse dose of steroids and transferred to a transplant center for lung transplantation evaluation. Discussion: Acute interstitial pneumonia is a rare idiopathic clinicopathological condition that is characterized clinically by rapid onset of respiratory failure in patients with no past medical history of pre-existing lung disease. Histopathological findings are identical to those of diffuse alveolar damage. Closely resembling ARDS, it is frequently confused with other clinical entities characterized by rapidly progressive interstitial pneumonia. Considering this a high index of suspicion is required to diagnose these patients and institute appropriate management as mortality is as high as 70%. (Figure Presented).
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The purpose of this study was to conduct a correlative assessment of SARS-CoV-2 RNA concentrations in wastewater with COVID-19 cases and a systematic evaluation of the effect of using different virus concentration methods and recovery and normalization approaches. We measured SARS-CoV-2 RNA concentrations at two different wastewater treatment plants (WWTPs) in the Bexar County of Texas from October 2020 to May 2021 (32 weeks) using reverse transcription droplet digital PCR (RT-ddPCR). We evaluated three different adsorption-extraction (AE) based virus concentration methods (acidification, addition of MgCl2, or without any pretreatment) using bovine coronavirus (BCoV) as surrogate virus and observed that the direct AE method showed the highest mean recovery. COVID-19 cases were correlated significantly with SARS-CoV-2 N1 concentrations in Salitrillo (rho = 0.75, p < 0.001) and Martinez II (rho = 0.68, p < 0.001) WWTPs, but normalizing to a spiked recovery control (BCoV) or a fecal marker (HF183) reduced correlations for both treatment plants. The results generated in this 32-week monitoring study will enable researchers to prioritize the virus recovery method and subsequent correlation studies for wastewater surveillance.
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INTRODUCTION: Myocarditis is increasingly being reported after mRNA COVID-19 vaccination especially in young individuals. We aim to compile the clinical, laboratory, and investigational data on reported cases of post-COVID-19 vaccination in adults and assess the clinical features, investigational findings, and prognosis in this meta-analysis. METHODS: PubMed database was searched using keywords for post-COVID-19 vaccination myocarditis for articles published before July 6th, 2021. 37 unique studies were identified. Case reports and case series published in English which reported individual patient data on adults aged 18 years or older that were hospitalized for presumed post mRNA vaccination myocarditis are included in our study. Pre-prints were included if they had individual patient data. Editorials, correspondence, reviews, perspectives, original articles were excluded. 13 articles met our criteria for inclusion. Individual participant data was tabulated on a spreadsheet. Age, time of presentation, and length of stay are expressed as Median. The rest of the findings are mentioned as frequency (n). RESULTS: Post mRNA vaccination myocarditis is predominantly seen in males with a mean age of 27.5 years and more after their second dose of vaccination. It is reported after both Pfizer-BioNTech and Moderna vaccine use. The median time of hospital presentation was 3 days after vaccination. The main presenting symptom is chest pain in 96.7% of the patients. Troponin was elevated and cardiac MRI showed late gadolinium enhancement in all the patients. The mean hospital length of stay was 5.5 days. All the patients made a good recovery. CONCLUSION: Post COVID-19 myocarditis is possibly a hypersensitivity reaction to mRNA vaccines. It is predominantly seen in young males and is characterized by chest pain, elevated troponin, and abnormal cardiac MRI. The condition carries a good prognosis. Further investigations are necessary to understand the underlying pathogenesis.
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Introduction: Tolebrutinib is a covalent, irreversible, central nervous system (CNS)-penetrant Bruton's tyrosine kinase inhibitor targeting B lymphocytes and myeloid cells (eg, macrophages and microglia), thereby modulating innate and adaptive immunity in the periphery and CNS. Results from the phase 2b trial (NCT03889639) demonstrated that tolebrutinib was well tolerated over a 12-week period and identified a dose-dependent reduction in new gadolinium-enhancing T1 lesions and new/ enlarging T2 lesions in people with relapsing MS (pwRMS);the selected dose was 60 mg/day. Patients who completed the tolebrutinib phase 2b trial were eligible for enrolment in the ongoing long-term safety and efficacy extension study (NCT03996291). Aims: Describe the safety and efficacy of tolebrutinib in pwRMS at 48 weeks in the long-term extension study. Methods: The extension study consisted of 2 parts: in Part A, participants continued double-blind treatment with the same tolebrutinib dose as administered in the core study (5, 15, 30 or 60 mg/ day);in Part B, participants received open-label treatment with the 60-mg dose, which is being tested in the phase 3 trials GEMINI 1 (NCT04410978) and GEMINI 2 (NCT04410991). Safety was the primary endpoint. Secondary endpoints included clinical efficacy outcomes (annualised relapse rate and change from baseline in Expanded Disability Status Scale score). Results: Of 130 participants randomised in the phase 2b trial, 129 completed the core study and 125 enrolled in the long-term extension study. Of these participants, 2 (2%) discontinued due to adverse events and 1 (1%) was lost to follow-up as of 5 March, 2021. To date, no new safety signals have been observed over the duration of exposure in this study. The most common treatmentemergent adverse events occurring in & ge;5% of participants were headache (10% [13/125]), COVID-19 (9% [11/125]), upper respiratory tract infection (8% [10/125]) and nasopharyngitis (7% [9/125]). There was no suggestion of a dose effect for treatmentemergent or serious adverse events in Part A and no emergence of new safety signals for participants who switched to the 60-mg dose. The analysis of clinical efficacy outcomes is ongoing and will be presented at the meeting. Conclusions: Safety data from the long-term extension study of tolebrutinib in pwRMS continue to show favourable tolerability, without the emergence of any new safety signals.
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SESSION TITLE: Fellows Diffuse Lung Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Nonspecific interstitial pneumonia (NSIP) is the second most common cause of idiopathic interstitial pneumonias. Even though ground glass capacities (GGOs) are thought to be the predominant feature of NSIP with high sensitivity, this disease has a varied presentation. Hence, reliance on imaging solely for its diagnosis can be erroneous. Here we present a case of cellular NSIP with atypical radiological findings. CASE PRESENTATION: A 61-year-old female with history of chronic kidney disease presented with cough with productive sputum and dyspnea. She had a similar admission two months ago with hypoxic respiratory failure requiring oxygen with high flow nasal cannula. CT chest showed multifocal airspace consolidations bilaterally. She was initially treated with antibiotics with no significant improvement following which steroids were added for severe pneumonia resulting in rapid improvement of her symptoms. Hence, she was thought to have a steroid responsive lung disease such as acute eosinophilic pneumonia or organizing pneumonia and was discharged on a tapering dose of steroids with a plan for outpatient follow-up. However, patient did not follow up and presented with recurring symptoms two weeks after discontinuing the steroids. CT of her chest again showed multifocal new confluent airspace consolidations in bilateral lung fields with improvement of old consolidation. She underwent bronchoscopy with transbronchial cryobiopsy showing cellular NSIP. She was started on high dose steroids with subsequent improvement and was discharged on prednisone 40 mg daily. No clear etiology for NSIP could be identified. She was then started on mycophenolate as an outpatient for steroid sparing effect. Unfortunately, she returned to the hospital with a diagnosis of COVID-19 pneumonia and subsequently passed away. DISCUSSION: Lower lobe predominant GGOs with reticular abnormality and traction bronchiectasis are most common CT findings of NSIP. Patchy airspace consolidations are characteristic for eosinophilic lung disease or organizing pneumonia but is an uncommon finding in NSIP. It is essential to make a definitive diagnosis as each of these have different prognoses and treatment durations. Our case demonstrates that NSIP should be considered in the differential for patchy consolidative lung disease especially when steroid responsive and recurrent. Cryobiopsy in this case was instrumental in making this diagnosis without subjecting the patient to an an open lung biopsy. CONCLUSIONS: NSIP has variable clinical, pathological and radiological manifestations and is usually hard to differentiate from other form of diffuse lung diseases such as organizing pneumonia or HP. Reference #1: Kligerman, Seth et al (2009). Nonspecific Interstitial Pneumonia: Radiologic, Clinical, and Pathologic Considerations. Radiographics;Inc. 29. 73-87. 10.1148/rg.291085096. Reference #2: Saraya, T., Takata, S., Fujiwara, M., & Takei, H. (2013). Cellular non-specific interstitial pneumonia masquerading as congestive heart failure. BMJ case reports, 2013, bcr2013010502. https://doi.org/10.1136/bcr-2013-010502 DISCLOSURES: No relevant relationships by Sadia Benzaquen, source=Web Response No relevant relationships by Ena Gupta, source=Web Response No relevant relationships by ATUL MATTA, source=Web Response No relevant relationships by Corrado Minimo, source=Web Response
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SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: COVID-19 has affected millions of people all over the world with high mortality. This impact is greater in the low socioeconomic patient population. There has been debate on whether the ARDS due to COVID-19 is typical ARDS or the variant phenotypes L and H. We describe the clinical characteristics, ventilator mechanics, and outcomes in an underserved African American patient population. METHODS: This is a single-center retrospective observational study. We included all adult patients with laboratory-confirmed COVID-19 discharged from our ICU between March 15-April 25, 2020. We collected demographic data, laboratory values, respiratory mechanics and clinical outcomes RESULTS: Sixty-one critical ill adult patients with confirmed SARS-Cov-2 were included in the study. Median age was 70 (IQR 61-77) and 31 patients (51%) were female. 21% of patients had preexisting pulmonary disease and almost half were current or former smokers. Hypertension was present in 85% and Diabetes Mellitus in 62% of the patients. Fifty-one patients (83.6%) had two or more comorbidities. On intubation the median PEEP was 8 cm H2O (IQR 5-10), plateau pressure was 25 cm H2O (IQR22-30) and compliance was 26 ml/cmH2O (IQR 21-33). There was a significantly lower mean PF ratio on admission compared to PF ratios 3 days after (p=0.014). The FiO2 requirements were significantly higher on admission compared to 3 days after (89.62 vs 57.71 p=0.005). Compliance increased from the date of admission to day 3 but was not statistically significant. Mechanical ventilation was required in 82% of patients. Prone positioning was done for 30% of patients and had less mortality of 29.7% vs 36.8% (p=0.763). Overall, the mortality rate was 66%. Withdrawal of care was done in 37.7% of patients. Successful extubation rate was 23%. CONCLUSIONS: Our patients presented with the typical low compliance ARDS. The mortality in critically ill COVID-19 patients is high. Increasing age, African Americans, and patients with multiple comorbid conditions are at increased risk of morbidity and mortality. CLINICAL IMPLICATIONS: N/A DISCLOSURES: No relevant relationships by Zurab Azmaiparashvili, source=Web Response No relevant relationships by Sadia Benzaquen, source=Web Response No relevant relationships by Siddique Chaudhary, source=Web Response No relevant relationships by Kevin Bryan Lo, source=Web Response No relevant relationships by ATUL MATTA, source=Web Response No relevant relationships by Gabriel Patarroyo - Aponte, source=Web Response