ABSTRACT
BACKGROUND: Interleukin-6 blockade (IL-6) has become a focus of therapeutic investigation for the coronavirus disease 2019 (COVID-19). METHODS: We report a case of a 34-year-old with COVID-19 pneumonia receiving an IL-6 receptor antagonist (IL-6Ra) who developed spontaneous colonic perforation. This perforation occurred despite a benign abdominal exam and in the absence of other known risk factors associated with colonic perforation. RESULTS: Examination of the colon by electron microscopy revealed numerous intact severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virions abutting the microvilli of the colonic mucosa. Multiplex immunofluorescent staining revealed the presence of the SARS-CoV-2 spike protein on the brush borders of colonic enterocytes that expressed angiotensin-converting enzyme 2. However, no viral particles were observed within the enterocytes to suggest direct viral injury as the cause of colonic perforation. CONCLUSIONS: These data and absence of known risk factors for spontaneous colonic perforation implicate IL-6Ra therapy as the potential mediator of colonic injury in this case. Furthermore, this report provides the first in situ visual evidence of the virus in the colon of a patient presenting with colonic perforation adding to growing evidence that intact infectious virus can be present in the stool.
ABSTRACT
Dental professionals are at an increased risk for exposure to the severe acute respiratory syndrome coronavirus 2 with aerosol-generating procedures (AGPs), and dental anesthesia practices have additional risks due to airway management procedures. The purpose of this pilot study was to examine the extent of splatter on dental personnel that may occur with AGPs and coughing in a dental anesthesia practice. A Dentoform model was fitted into a dental mannequin and coated with Glo Germ to detect splatter during simulated dental AGPs produced with use of a high-speed handpiece, an ultrasonic scaler, and an air-water syringe, all in conjunction with high-volume suction. A simulated cough was also created using a ventilator programmed to expel Glo Germ within the velocity and volume parameters of a natural cough with dental personnel in their customary positions. A UV light was used after each procedure to systematically evaluate the deposition of Glo Germ splatter on each person. After AGPs were performed, splatter was noted on the face, body, arms, and legs of the dentist and dental assistant. The simulated cough produced more extensive splatter than AGPs; additional Glo Germ was seen on the shoes, the crown of the head, and the back of the dental personnel. Therefore, it is recommended that full personal protective equipment consistent with AGPs be used and changed between patients to reduce the risk of contamination and infection for dental personnel and patients.