Targeting Bacteria within Us to Diminish Infection and Autoimmunity.

Antibiotics improve clinical outcomes independent of their antibacterial effects. In this issue of Immunity, Almeida et al. and Colaço et al. demonstrate that antibiotic impairment of mitochondrial ribosomes modulates both T-cell-dependent inflammation and host tolerance to infection.

Risk stratification of hospitalized COVID-19 patients through comparative studies of laboratory results with influenza.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 overlaps with the flu season. METHODS: We compared clinical and laboratory results from 719 influenza and 973 COVID-19 patients from January to April 2020. We compiled laboratory results from the first 14 days of the hospitalized patients using parameters that are most significantly different between COVID-19 and influenza and hierarchically clustered COVID-19 patients. FINDINGS: Compared to influenza, patients with COVID-19 exhibited a continued increase in white blood cell count, rapid decline of hemoglobin, more rapid increase in blood urea nitrogen (BUN) and D-dimer, and higher level of alanine transaminase, C-reactive protein, ferritin, and fibrinogen. COVID-19 patients were sub-classified into 5 clusters through a hierarchical clustering analysis. Medical records were reviewed and patients were risk stratified based on the clinical outcomes. The cluster with the highest risk showed 27·8% fatality, 94% ICU admission, 94% intubation, and 28% discharge rates compared to 0%, 38%, 22%, and 88% in the lowest risk cluster, respectively. Patients in the highest risk cluster had leukocytosis including neutrophilia and monocytosis, severe anemia, increased red blood cell distribution width, higher BUN, creatinine, D-dimer, alkaline phosphatase, bilirubin, and troponin. INTERPRETATION: There are significant differences in the clinical and laboratory courses between COVID-19 and influenza. Risk stratification in hospitalized COVID-19 patients using laboratory data could be useful to predict clinical outcomes and pathophysiology of these patients. FUNDING: National Institute of Diabetes and Digestive and Kidney Disease, Department of Defense, and National Heart, Lung, and Blood Institute.

Atypical lymphocytes in peripheral blood of patients with COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, China rapidly became a pandemic across the world, including the US. Since March 2020, we started to received peripheral blood smear review consults for the patients who were admitted with COVID-19. We reviewed 15 peripheral blood smears from 15 most recently admitted patients (Table 1). These patients range from 26 to 90 years of age and include 8 males and 7 females. The reasons for peripheral blood smear consult were primarily concerns for hemolysis (9 out of 15 cases), followed by anemia, thrombocytopenia, and pancytopenia.