ABSTRACT
We retrospectively studied nasopharyngeal severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load in coronavirus disease 2019 (COVID-19) patients who were hospitalized between January 13 and April 1, 2020. Quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) was conducted using primers and probes targeting the ORF1ab and N genes. All patients were classified in the following groups: Group 1: received favipiravir + chloroquine or hydroxychloroquine + lopinavir/ritonavir or darunavir/ritonavir for 5-10 days, Group 2: received chloroquine or hydroxychloroquine + lopinavir/ritonavir or darunavir/ritonavir for 5-10 days, and Group 3: no antiviral medication. Among the 115 patients, 38 (33%), 54 (47%), and 23 (20%) were in Groups 1, 2, and 3, respectively. The median (IQR) baseline viral loads on day 0 of Groups 1, 2, and 3 were 7.2 (6.0-8.1), 6.9 (5.8-7.8), and 6.9 (5.8-7.6) log10 copies/mL, respectively. The reductions of mean viral loads on day 3 from baseline were 2.41, 1.38, and 2.19 log10 copies/mL in the corresponding groups (P < 0.05). There were no differences in the reduction of mean viral loads from baseline among the three groups on days 5 and 10 (P > 0.05). Multiple logistic regression analysis showed that receiving favipiravir was associated with nasopharyngeal viral load reduction at three days (P = 0.001). Significant nasopharyngeal SARS-CoV-2 viral load reduction was achieved in COVID-19 patients who received a favipiravir-containing regimen.
Subject(s)
Amides/therapeutic use , Antiviral Agents/therapeutic use , COVID-19 Drug Treatment , Pyrazines/therapeutic use , SARS-CoV-2/drug effects , Viral Load/drug effects , Adult , COVID-19/diagnosis , COVID-19/virology , Drug Therapy, Combination , Female , Hospitalization , Humans , Male , Middle Aged , Nasopharynx , Retrospective Studies , SARS-CoV-2/isolation & purification , Treatment OutcomeABSTRACT
Clinical spectrum of Coronavirus Disease 2019 (COVID-19) remains unclear, especially with regard to the presence of pneumonia. We aimed to describe the clinical course and final outcomes of adult patients with laboratory-confirmed COVID-19 in the full spectrum of disease severity. We also aimed to identify potential predictive factors for COVID-19 pneumonia. We conducted a retrospective study among adult patients with laboratory-confirmed COVID-19 who were hospitalized at Bamrasnaradura Infectious Diseases Institute, Thailand, between January 8 and April 16, 2020. One-hundred-and-ninety-three patients were included. The median (IQR) age was 37.0 (29.0-53.0) years, and 58.5% were male. The median (IQR) incubation period was 5.5 (3.0-8.0) days. More than half (56%) of the patients were mild disease severity, 22% were moderate, 14% were severe, and 3% were critical. Asymptomatic infection was found in 5%. The final clinical outcomes in 189 (97.9%) were recovered and 4 (2.1%) were deceased. The incidence of pneumonia was 39%. The median (IQR) time from onset of illness to pneumonia detection was 7.0 (5.0-9.0) days. Bilateral pneumonia was more prevalent than unilateral pneumonia. In multivariable logistic regression, increasing age (OR 2.55 per 10-year increase from 30 years old; 95% CI, 1.67-3.90; p<0.001), obesity (OR 8.74; 95%CI, 2.06-37.18; p = 0.003), and higher temperature at presentation (OR 4.59 per 1°C increase from 37.2°C; 95% CI, 2.30-9.17; p<0.001) were potential predictive factors for COVID-19 pneumonia. Across the spectrum of disease severities, most patients with COVID-19 in our cohort had good final clinical outcomes. COVID-19 pneumonia was found in one-third of them. Older age, obesity, and higher fever at presentation were independent predictors of COVID-19 pneumonia.
Subject(s)
Coronavirus Infections/diagnosis , Disease Progression , Pneumonia, Viral/diagnosis , Adult , Age Factors , Aged , Betacoronavirus , COVID-19 , Female , Fever/etiology , Hospitalization , Humans , Male , Middle Aged , Obesity/complications , Pandemics , Prognosis , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , SARS-CoV-2 , Symptom Assessment , Thailand/epidemiology , Young AdultABSTRACT
Background: Favipiravir is a promising drug for COVID-19, but evidence from a robust clinical trial is limited. Objective: To describe the demographics, clinical characteristics, and various antiviral treatment regimens (with and without favipiravir) of patients with severe and nonsevere COVID-19. Method: We conducted a retrospective observational study in all COVID-19 patients admitted at Bamrasnaradura Infectious Diseases Institute (BIDI) from January 8 to March 30, 2020. We compared the demographics, clinical characteristics, and various antiviral treatment regimens of 12 severe and 29 nonsevere COVID-19 patients in Thailand. Results: Adjunctive favipiravir was given to only severe cases. The median length of hospitalization of patients either receiving favipiravir or not receiving favipiravir was not significantly different (P = 0.8549), but those who received adjunctive favipiravir became reverse transcriptase-polymerase chain reaction negative 2 days sooner than the other group (median: 6 days vs. 8 days;P = 0.1125). Conclusion: The findings suggested that adjunctive favipiravir might not be effective for patients with severe COVID-19, but further studies with larger sample sizes are needed.
ABSTRACT
Coronavirus disease 2019 (Covid-19) has non-specific clinical and laboratory characteristics that might be similar to other viral infection including dengue. Two Covid-19 cases with 'false-positive' dengue serology have been reported in Singapore but no public health consequence was described. We describe a Thai patient with an initial diagnosis of dengue fever who was later confirmed to also infect with SARSCoV-2. The Covid-19 infection appeared to spread to one family member and one healthcare worker.
ABSTRACT
We report a 35-year-old female nurse who possibly received the SARS-CoV-2 virus during the blood sampling of a 35-year-old male patient initially suspected as a dengue infection. The patient had mild thrombocytopenia and positive dengue IgG and IgM whereas the clinicians were not aware of the possibility of false-positive dengue serology revealed in the published case report from Singapore. The nurse put on a pair of gloves but did not wear a mask during the only encounter with this patient. This nosocomial transmission raised a safety concern among healthcare professionals in an area with a relatively low Covid-19 prevalence, especially when the clinical and laboratory characteristics could be confused with other viral infections.
Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/transmission , Diagnostic Errors , Infectious Disease Transmission, Patient-to-Professional , Pneumonia, Viral/transmission , Adult , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Dengue/diagnosis , Dengue/virology , Dengue Virus/pathogenicity , Dengue Virus/physiology , Female , Humans , Male , Nurse Practitioners , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , ThailandABSTRACT
Among 11 patients in Thailand infected with severe acute respiratory syndrome coronavirus 2, we detected viral RNA in upper respiratory specimens a median of 14 days after illness onset and 9 days after fever resolution. We identified viral co-infections and an asymptomatic person with detectable virus RNA in serial tests. We describe implications for surveillance.