Severe systemic thrombosis in a young COVID-19 patient with a rare homozygous prothrombin G20210A mutation

COVID-19 patients may experience a hypercoagulable condition, leading to thrombotic events. We describe a patient with COVID-19, carrying a rare homozygous mutation of the prothrombin gene, who developed a severe systemic vein thrombosis. In COVID-19 patients with hypercoagulability disorders the most common inherited and acquired risk factors should be investigated.

Two nasal swabs may not be enough to exclude SARS-CoV-2 infection in symptomatic patients.

Abstracts: The spread of COVID-19 (COronaVIrus Disease 2019), due to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2) has taken on dramatic pandemic proportions, affecting over 100 countries in a matter of weeks. Italy has had 237,828 confirmed cases according to the Istituto Superiore di Sanità as of May 13, and 34,448 deaths (1).

Peculiar clinical presentation of COVID-19 and predictors of mortality in the elderly: A multicentre retrospective cohort study.

BACKGROUND: The spectrum of COVID-19 clinical manifestations is not yet known. In the elderly, mortality and extrapulmonary involvement appears more frequent than expected. METHODS: A multicentre-retrospective-case-series study of COVID-19 patients, aged ≥65 years, hospitalised between March 1 and June 15, 2020. Patients were classified at admission into 3 groups based on their Clinical Frailty Scale (CFS) score: 1-3 (group A), 4-6 (group B) and 7-9 (group C). RESULTS: Of the 206 patients in the study, 60 (29%) were assigned to group A, 60 (29%) to B and 86 (42%) to C. Significantly more frequent in group C than in B or A were: mental confusion (respectively 65%, 33%, 7%; P < 0.001), kidney failure (39%, 22%, 20%; P = 0.019), dehydration syndrome (55%, 27%, 13%; P < 0.001), electrolyte imbalance (54%, 32%, 25%; P = 0.001), and diabetic decompensation (22%, 12%, 7%; P = 0.026). Crude mortality was 27%. By multivariate logistic regression model independent predictors of death were male sex (adjusted odds ratio (aOR) = 2.87,95%CI = 1.15-7.18), CFS 7-9 (aOR = 9.97,95%CI = 1.82-52.99), dehydration at admission (aOR = 4.27,95%CI = 1.72-10.57) and non-invasive/invasive ventilation (aOR = 4.88,95%CI = 1.94-12.26). CONCLUSIONS: Elderly patients with a high CFS showed frequent extrapulmonary signs at admission, even in the absence of lung involvement. These findings, along with a high CFS, predicted a significant risk of mortality.

Tocilizumab and corticosteroids for covid-19 treatment in elderly patients

Background. The mortality rate for coronavirus disease-19 (COVID-19) increases with age. Some anti-inflammatory drugs such as tocilizumab or steroids have been proposed for the treatment of severe disease;however, few data are available in the elderly. Methods. A retrospective case-series of patients hospitalized between March 1st and June 15th, 2020 with confirmed COVID-19 by RT-PCR testing on throat/nasopharyngeal swabs and age ≥ 65 years was analysed. Patients were retrospectively divided into three groups according to the chosen treatment [standard of care (SOC), tocilizumab or corticosteroids] and patient characteristics and occurrence of adverse events were compared among groups. Results. Overall, 206 patients were included, 148 treated with standard of care, 42 with steroids and 16 with tocilizumab. Patients treated with steroids or Tocilizumab presented more frequently with fever (p =.003), dyspnea (p <.001), bilateral opacities/infiltrates at chest X-ray (p =.026) or CT-scan (p =.020), and more frequently required non-invasive/invasive ventilation (p <.001). Crude mortality was 27%, without differences among groups (p =.074). No specific adverse events were observed during/after the administration of steroids or tocilizumab;however, a trend towards an increased risk of secondary infections was described compared to SOC (p =.097). At multivariate logistic regression, only tocilizumab administration was an independent predictor of secondary infections (aOR = 6.72, 95% CI = 1.43-31.39, p =.015). Conclusions. Tocilizumab and corticosteroid could have a possible role for severe form of pneumonia in course of COVID-19 also in elderly patients, even if great attention to the monitoring of infectious complications should be paid in this special population.

Seroprevalence of SARS-COV-2 antibodies in Southern Italy's hospital staff

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the first pandemic caused by a coronavirus. Respiratory/aerial droplets transmission and the high number of "hidden" asymptomatic cases play a critical role in the rapid spread of the virus across countries. The seroprevalence of SARS-CoV-2 antibodies in the general population is currently unknown. It has been estimated that undocumented infections were the source for #80% of the documented cases before traveling restriction policies took place. Serological evaluation is essential for investigating the extent of SARS-CoV-2. Even more, assessing the prevalence of anti-SARSCoV-2 in hospital staff offers a unique opportunity to study the correlation between seroconversion and immunization because of their occupational exposure and at higher risk of contagious. Methods: The study enrolled a total of 3242 employees of our hospital, "Policlinico Riuniti" of Foggia. The employees' group was stratified in 3 subgroups according to their relative exposure to SARS-CoV-2 (high, intermediate, and low-risk groups). We used a chemiluminescent immunoassay (CLIA, Shenzhen YHLO Biotech) to study the seroprevalence of SARS-COV-2 specific antibodies (IgG and IgM against nucleocapsid and spike proteins). The cut-off was set to 8 AU/mL for both IgG and IgM (specificity of 98,8% and 100%, respectively). A control group of 83 samples sera collected before the Italian COVID-19 outbreak (2018-19) was also tested. Healthcare workers with IgG or IgM concentration above 6.0 and below 8.0 AU/mL were considered borderline. Nevertheless, all of them were tested for the SARS-CoV-2 viral RNA presence (Allplex™ 2019 n-CoV Assay, Seegene). Results: Sixty-two individuals (1.9%, 1.4-2.3%, 95% CI) tested positive for at least one antibody anti-SARS-CoV-2. Five individuals (8.0% of the positive) had IgG and IgM positive test results, while 32 and 25 had only IgG and only IgM positive results. Instead, viral RNA was detected in only nine individuals (13.8% of Ig positive) by RTPCR. The cumulative proportion of individuals who tested positive (IgG and/or IgM) varied between 1-2.4%. The seroprevalence was lower in the high-risk group 1.4% (6/428,0.5-2.6%, 95% CI) vs. intermediate-risk group 2.0 % (55/2736, 1.5-2.5%, 95% CI). Only one participant (1.3%, 0-3.8%, 95% CI) of the low-risk group tested positive for SARS-CoV-2 IgM antibodies. Conclusions: The low level of seropositivity (1.9%) shows that the COVID-19 containment measures adopted were adequate and effective. Moreover, the combination of both serological and molecular tests can improve the likelihood of identifying asymptomatic subjects.