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This study analyzed the impact of COVID-19 outbreak and targeted required reserve ratio cut policy on stock returns of Chinese listed companies. This paper uses the data of 3,449 A-share listed companies from February 3, 2020 to December 31, 2020 for research, the empirical results showed that stock prices of private enterprises with stronger debt-paying ability and looser financing constraints, and state-owned enterprises with less supply chain credit risks performed better, in the central and western regions, enterprises with stronger solvency and looser financing constraints have better stock price performance during the early stages of pandemic. After the implementation of the targeted RRR cut policy, the stock prices of enterprises with poor solvency, private enterprises, and enterprises in central and western regions with strong financing constraints, state-owned enterprises, and enterprises in eastern region with high credit risks all showed significant reversals, and the stock prices reflected the effect of the targeted RRR cut policy in the short and medium term. Over time, the pandemic has been controlled, and the resumption of work and production has freed most enterprises from financial difficulties. However, due to sporadic outbreaks, large private enterprises and eastern enterprises with strong risk resistance and loose financing constraints enjoy better stock price performance. This study is helpful for enterprises to understand the value of financial flexibility and solvency and provides a reference for enterprises to make financial decisions: how to balance the benefits and costs of solvency. © Tian Wang, Fang Fang and Linhao Zheng, 2023.
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The COVID-19 pandemic may have been a difficult time to join a new organization. Drawing on the feelings-as-information theory, this study explores how COVID-19 lockdown anxiety influenced newcomers' job satisfaction during their first few months of work. We tested 357 new employees working in 84 cities across China. We conducted a longitudinal study, and participants were invited to complete the same survey at two time points. Cross-lagged panel analysis was conducted to test our hypotheses. We confirmed that COVID-19 lockdown anxiety at Time 1 predicted less job satisfaction at Time 2, whereas the data did not support the idea of reverse causality. These findings suggest public health crises like the pandemic can impact newcomers' job satisfaction, especially during China's Zero-Covid Policy.
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Biomarker detection has attracted increasing interest in recent years due to the minimally or non-invasive sampling process. Single entity analysis of biomarkers is expected to provide real-time and accurate biological information for early disease diagnosis and prognosis, which is critical to the effective disease treatment and is also important in personalized medicine. As an innovative single entity analysis method, nanopore sensing is a pioneering single-molecule detection technique that is widely used in analytical bioanalytical fields. In this review, we overview the recent progress of nanopore biomarker detection as new approaches to disease diagnosis. In highlighted studies, nanopore was focusing on detecting biomarkers of different categories of communicable and noncommunicable diseases, such as pandemic COVID-19, AIDS, cancers, neurologic diseases, etc. Various sensitive and selective nanopore detecting strategies for different types of biomarkers are summarized. In addition, the challenges, opportunities, and direction for future development of nanopore-based biomarker sensors are also discussed.Copyright © 2023 Elsevier B.V.
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Background: Novel coronavirus disease (SARS-COV-2 infection or COVID-19) is a respiratory tract infection that has been linked to severe acute respiratory syndrome transmitted particularly through touching and respiration. The purpose of this study is to understand the epidemiological characteristics of COVID-19 cases in a typical tourist-related outbreak and explore the possible route for its transmission. Method(s): All data and epidemiological survey reports of COVID-19 cases in the outbreak were reported by provincial and urban (county) Centers for Disease Control and Prevention and Health Commissions nationwide from October 16th to November 5th, 2021. The epidemiological survey reports included information on gender, age, source of infection (imported from other provinces or locally acquired), daily life track and itinerary, date of symptom onset, and date of diagnosis. The data were analyzed using descriptive statistical methods, one-way analysis of variance, independent t-test, and Chi-square tests. Histograms and percentage stacked area plots were used to describe the epidemiological characteristics of the outbreaks. Result(s): The COVID-19 outbreak associated with the tourist groups has involved 551 COVID-19 cases, with a median age of 44 years (interquartile range: 30-59 years), gradually spreading from the northwestern region to the national level across 15 provinces of China. One-fifth of the cases (16.0%) had traveled to Ejin Banner, resulting in 68 second-generation cases. We estimated an outbreak on 11 flights and 19 trains, accounting for a total of 27 confirmed cases. In addition, 42 clusters of outbreak cases were also reported to occur, 21 (50.0%) in households and 10 (23.81%) in restaurants. About 106 confirmed cases were related to the gatherings in restaurants. The median incubation period for this COVID-19 outbreak was 7 days (inter-quartile range: 5-10 days). Conclusion(s): The survey results indicated that this COVID-19 outbreak originated in Ejin Banner and was spread by tourist groups, which was a typical infection outbreak promoted by travel. Our results further confirmed that travel needs to be more strictly weighed in pandemics like COVID-19, and people need to pay more attention to the prevention against infectious diseases, particularly when traveling in a tourist group.Copyright © 2022 Zheng et al.
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With the outbreak of COVID-19, a large number of relevant studies have emerged in recent years. We propose an automatic COVID-19 diagnosis model based on PVTv2 and the multiple voting mechanism. To accommodate the different dimensions of the image input, we classified the images using the Transformer model, sampled the images in the dataset according to the normal distribution, and fed the sampling results into the PVTv2 model for training. A large number of experiments on the COV19-CT-DB dataset demonstrate the effectiveness of the proposed method. Our method won the sixth place in the (2nd) COVID19 Detection Challenge of ECCV 2022 Workshop: AI-enabled Medical Image Analysis - Digital Pathology & Radiology/COVID19. Our code is publicly available at https://github.com/MenSan233/Team-Dslab-Solution. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The idea of mRNA therapy had been conceived for decades before it came into reality during the Covid-19 pandemic. The mRNA vaccine emerges as a powerful and general tool against new viral infections, largely due to its versatility and rapid development. In addition to prophylactic vaccines, mRNA technology also offers great promise for new applications as a versatile drug modality. However, realizing the conceptual potential faces considerable challenges, such as minimal immune stimulation, high and long-term expression, and efficient delivery to target cells and tissues. Here we review the applications of mRNA-based therapeutics, with emphasis on the innovative design and future challenges/solutions. In addition, we also discuss the next generation of mRNA therapy, including circular mRNA and self-amplifying RNAs. We aim to provide a conceptual overview and outlook on mRNA therapeutics beyond prophylactic vaccines. © 2023
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Objective To analyze the detection of SARS-CoV-2 in household environment and public place environment of Huangpu District, and describe the feature of SARS-CoV-2 contamination in the environment exposure to the infected cases, so as to support the control strategies such as disinfection and health communication. Methods The results of RT-PCR test for the environmental samples exposure to the cases infected by SARS-CoV-2 during February 1 to March 31 2022 in Huangpu District of Shanghai were collected as the research data. Pearson χ2 was used to test the significance of the differences between positive rates of SARS-CoV-2 contamination. Results From February 1 to March 31, household environment samples had a higher positive rate (6.47%, 234/3 618) of SARS-CoV-2 contamination while the public place samples had a lower one (1.22%, 47/3 582) in Huangpu District of Shanghai (χ2=141.908, P<0.01). Among the household buildings, the lane houses of old style representing poorer living condition had the highest positive rates (8.31%, 96/1 155) of SARS-CoV-2 contamination while the apartments representing better living condition had the lowest (3.59%, 22/612) (F=5.25 P<0.05). Among the samples from household environment, samples regarding sewerage had the highest positive rates (13.30%, 58/436) of SARS-CoV-2 contamination, while samples regarding the tool of cooking and sweeping had the lowest (3.10%, 17/548) (F=9.84 P<0.01). Among the samples from public place environment, samples regarding entertainment tools had the highest positive rates (13.33%, 2/15) of SARS-CoV-2 contamination, while samples regarding the tool of cooking and sweeping had the lowest (0.62%, 4/646) (F=4.22 P<0.01). Conclusion In the environment exposure to the SARS-CoV-2 infected cases, the disinfection, ventilation and cleaning should be intensified strictly. SARS-CoV-2's surviving in sewage environment should be evaluation dynamically. More health communication should be pushed to people of poorer living condition. © 2022 Editorial Office of Chinese Journal of Schistosomiasis Control. All rights reserved.
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Background: Novel coronavirus disease (SARS-COV-2 infection or COVID-19) is a respiratory tract infection that has been linked to severe acute respiratory syndrome transmitted particularly through touching and respiration. The purpose of this study is to understand the epidemiological characteristics of COVID-19 cases in a typical tourist-related outbreak and explore the possible route for its transmission. Method(s): All data and epidemiological survey reports of COVID-19 cases in the outbreak were reported by provincial and urban (county) Centers for Disease Control and Prevention and Health Commissions nationwide from October 16th to November 5th, 2021. The epidemiological survey reports included information on gender, age, source of infection (imported from other provinces or locally acquired), daily life track and itinerary, date of symptom onset, and date of diagnosis. The data were analyzed using descriptive statistical methods, one-way analysis of variance, independent t-test, and Chi-square tests. Histograms and percentage stacked area plots were used to describe the epidemiological characteristics of the outbreaks. Result(s): The COVID-19 outbreak associated with the tourist groups has involved 551 COVID-19 cases, with a median age of 44 years (interquartile range: 30-59 years), gradually spreading from the northwestern region to the national level across 15 provinces of China. One-fifth of the cases (16.0%) had traveled to Ejin Banner, resulting in 68 second-generation cases. We estimated an outbreak on 11 flights and 19 trains, accounting for a total of 27 confirmed cases. In addition, 42 clusters of outbreak cases were also reported to occur, 21 (50.0%) in households and 10 (23.81%) in restaurants. About 106 confirmed cases were related to the gatherings in restaurants. The median incubation period for this COVID-19 outbreak was 7 days (inter-quartile range: 5-10 days). Conclusion(s): The survey results indicated that this COVID-19 outbreak originated in Ejin Banner and was spread by tourist groups, which was a typical infection outbreak promoted by travel. Our results further confirmed that travel needs to be more strictly weighed in pandemics like COVID-19, and people need to pay more attention to the prevention against infectious diseases, particularly when traveling in a tourist group. Copyright © 2022 Zheng et al.
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Background: The coronavirus disease 2019 (COVID-19) pandemic has severely affected healthcare systems around the world. This study aimed to investigate the perceptions of cardiologists regarding how the COVID-19 pandemic has affected the clinical practice patterns for acute coronary syndrome (ACS). Method(s): A multicenter clinician survey was sent to 300 cardiologists working in 22 provinces in China. The survey collected demographic information and inquired about their perceptions of how the COVID-19 pandemic has affected ACS clinical practice patterns. Result(s): The survey was completed by 211 (70.3%) cardiologists, 82.5% of whom were employed in tertiary hospitals, and 52.1% reported more than 10 years of clinical cardiology practice. Most respondents observed a reduction in ACS inpatients and outpatients in their hospitals during the pandemic. Only 29.9% of the respondents had access to a dedicated catheter room for the treatment of COVID-19-positive ACS patients. Most respondents stated that the COVID-19 pandemic had varying degrees of effect on the treatment of acute ST-segment elevation myocardial infarction (STEMI), acute non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. Compared with the assumed non-pandemic period, in the designed clinical questions, the selection of coronary interventional therapy for STEMI, NSTEMI, and unstable angina during the COVID-19 pandemic was significantly decreased (all p < 0.05), and the selection of pharmacotherapy was increased (all p < 0.05). The selection of fibrinolytic therapy for STEMI during the pandemic was higher than in the assumed non-pandemic period (p < 0.05). Conclusion(s): The COVID-19 pandemic has profoundly affected ACS clinical practice patterns. The use of invasive therapies significantly decreased during the pandemic period, whereas pharmacotherapy was more often prescribed by the cardiologists. Copyright: © 2022 The Author(s).
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Literature has shown that temporal focus (TF) is closely related to mental health, and both of them are associated with meaning in life (MIL). Nevertheless, few studies have investigated the functional role of MIL in the relationship between TF and mental health, especially in the context of COVID-19. The present study aims to explore the mediating role of MIL between different categories of TF (i.e., past, present, and future TF) and mental health. A two-wave longitudinal survey was conducted among 538 Chinese participants aged between 22 and 70 (M ± SD = 35.07 ± 8.82). TF was assessed at Time 1, while MIL, anxiety, and life satisfaction were measured at Time 2. The results of SEM showed that past TF negatively predicted MIL, while present and future TF positively predicted MIL. In addition, MIL mediated the relationship between TF and mental health indicators (anxiety and life satisfaction). Specifically, past TF demonstrated a negative indirect effect on life satisfaction by reducing MIL, while present and future TF had a positive indirect effect on life satisfaction by strengthening MIL. In contrast, past TF demonstrated a positive indirect effect on anxiety by reducing MIL, while present and future TF had a negative indirect effect on anxiety by strengthening MIL. Therefore, the present results supported the positive roles of present and future TF in promoting MIL and mental health during the COVID-19 pandemic. For the MIL intervention during the pandemic, the present findings suggested that compared to recalling the past, more attention should be paid to living in the present and hoping for the future. © The Author(s) 2022.
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The transformation of old and new technologies, the normalized crisis situation, and global economic integration blur industrial boundaries and cause the business pattern to fluctuate and become unsustainable, especially when considering the impact of the COVID-19 pandemic. This study focuses on crisis situations and combines the types of technology innovation (introduction, socialization, and differentiation) and sustainable business model innovation (efficiency, novelty, and co-benefit innovations) to theoretically analyze the dynamic impact of technology innovation on different types of sustainable business model innovations. Using a multi-case comparative analysis method, typical enterprises are selected as the sample cases. This study discusses the influences of different technology innovation schemes on sustainable business model innovation in different crisis situations. Enterprises should consider introducing technology for rapid value updates to maintain an efficient business model in an urgent production factor crisis, search for valuable and scarce technical components or introduce other entities to facilitate technical cooperation and form a novel business model in a market environment crisis, and use big data, artificial intelligence, and other technologies to create co-benefit business model innovation in a business ethics crisis. The conclusion guides enterprises and provides a framework for the optimal technical scheme under the corresponding crisis. © 2022 by the authors.
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On May 13, 2022, World Health Organization(WHO) Position Paper on Influenza Vaccine (2022 edition) was published. This position paper updates information on influenza epidemiology, high risk population, the impact of immunization on disease, influenza vaccines and effectiveness and safety, and propose WHO's position and recommendation that all countries should consider implementing seasonal influenza vaccine immunization programmes to prepare for an influenza pandemic. In addition, it proposes that the influenza surveillance platform can be integrated with the surveillance of other respiratory viruses, such as SARS-CoV-2 and Respiratory Syncytial Virus. This position paper has some implications for the prevention and control of influenza and other respiratory infectious diseases in China: (1) Optimize influenza vaccine policies to facilitate the implementation of immunization services; (2) Influenza prevention and control should from the perspective of Population Medicine focus on the individual and community to integrate with "Promotion, Prevention, Diagnosis, Control, Treatment, Rehabilitation"; (3) Incorporate prevention and control of other respiratory infectious diseases such as influenza, COVID-19, respiratory syncytial virus and adenovirus, and intelligently monitor by integrating multi-channel data to achieve the goal of co-prevention and control of multiple diseases.
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COVID-19 , Influenza Vaccines , Influenza, Human , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , SARS-CoV-2 , World Health OrganizationABSTRACT
Purpose Building supply chain resilience is increasingly recognized as an effective strategy to deal with supply chain challenges, risks and disruptions. Nevertheless, it remains unclear how to build supply chain resilience and whether supply chain resilience could achieve a competitive advantage. Design/methodology/approach By analyzing the data collected from 216 firms in China, the current study empirically examines how information technology (IT) capability and supply chain collaboration affect different forms of supply chain resilience (external resilience and internal resilience) and examines the performance implications of these two forms of supply chain resilience. Findings Results show that IT capability is positively related to external resilience, whereas supply chain collaboration is positively related to internal resilience. The combination of IT capability and supply chain collaboration is positively related to external resilience. In addition, internal resilience is positively related to firm performance. Research limitations/implications This study used only cross-sectional data from China for hypothesis testing. Future studies could utilise longitudinal data and research other countries/regions. Practical implications The findings systematically assess how IT capability and supply chain collaboration contribute to supply chain resilience and firm performance. The results provide a benchmark of supply chain resilience improvement that can be expected from IT capability and supply chain collaboration. Originality/value The study findings advance the understanding of supply chain resilience and provide practical implications for supply chain managers.
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Objective To detect the serum levels of SARS-CoV-2-specific IgM and IgG antibodies in patients infected with SARS-CoV-2 and recipients of inactivated vaccine in different periods for understanding their variation patterns in vivo. Methods Chemiluminescence immunoassay was used to detect the levels of SARS-CoV-2-specific IgM and IgG antibodies in 144 serum samples of 44 COVID-19 patients, 381 serum samples of 118 asymptomatic infected cases and 398 serum samples of 273 inactivated vaccine recipients collected at different periods. The results were statistically analyzed together with basic characteristics and vaccination status. Results The positive rates of IgM antibody in COVID-19 patients, asymptomatic infected cases and inactivated vaccine recipients were 52. 27% (23 / 44), 23. 73% (28 / 118) and 14. 29% (39 / 273). The positive rate of IgM antibody was higher in COVID-19 patients than in asymptomatic infected cases and vaccine recipients (χ2 = 12. 106, P = 0. 001;χ2 = 34. 755, P<0. 001). The positive rates of IgG antibody in the three populations were 100. 00% (44 / 44), 97. 46% (115 / 118) and 98. 81% (166 / 168), and the differences were not statistically significant (χ2 = 2. 944, P = 0. 229). In COVID-19 patients, the concentration of IgM antibody in <40 years old group was lower than that in ≥40 years old group (Waldχ2 = 6. 609, P = 0. 010), and the concentration of IgG antibody in patients with vaccination was higher than that in patients without vaccination (Waldχ2 = 12. 402,P<0. 001). In asymptomatic infected cases, the concentration of IgG antibody was higher in people with vaccination than in those without vaccination (Waldχ2 = 4. 530, P = 0. 033). In SARS-CoV-2 vaccine recipients, the concentration of IgG antibody in <40 years old group was higher than that in ≥40 years old group (Waldχ2 = 9. 565, P = 0. 002). Dynamic analysis of antibody levels showed that from week 1 to week 9, the concentrations of IgM and IgG antibodies in COVID-19 patients were higher than those in asymptomatic infected cases and vaccine recipients. Conclusions The concentrations of IgM and IgG antibodies in COVID-19 patients were higher than those in asymptomatic infected cases and inactivated vaccine recipients. COVID-19 patients aged ≥40 years had higher level of IgM antibody. COVID-19 patients and asymptomatic infected cases who had received vaccination had higher concentration of IgG antibody. Inactivated vaccine showed good immunogenicity after whole course of immunization, and the IgG antibody level in <40 years old group was higher.
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BACKGROUND: Aerosol-borne diseases such as COVID-19 may outbreak occasionally in various regions of the world, inevitably resulting in short-term shortage and corresponding reuse of disposable respirators. AIM: To investigate the effective disinfection methods, reusable duration and frequency of N95 respirators. METHODS: Based on the self-built respirator simulation test system, and under combinations of experimental conditions of three N95 respirators × 0-200 nm NaCl aerosols × three simulated breathing flow rates (15, 50 and 85 L/min) × two disinfection methods (dry heating and ultraviolet (UV) radiation), this study continuously measured the changes in filtration efficiency of all respirators during multi-cycles of '8-h simulated donning + disinfection' until the penetration reached ≥5%. FINDINGS: Multi-cycles of dry heating and UV radiation treatments on the reused (i.e., multiple 8-h donning) N95 respirators had a minimal effect (<0.5%) on the respirator filtration efficiency, and even at 85 L/min, all tested N95 respirators were able to maintain filtration efficiencies ≥95% for at least 30 h or four reuse cycles of '8-h donning + disinfection', while a lower breathing flow rate (15 L/min) plus the exhalation valve could further extend the N95 respirator's usability duration up to 140 h or 18 reuse cycles of '8-h donning + disinfection'. As the respirator wearing time extended, aerosol penetration slowly increased in a quadratic function with a negative second-order coefficient, and the penetration increment during each cycle of 8-h donning was less than 0.9%. CONCLUSION: Multi-cycles of N95 respirator reuse in combination with dry heating or UV irradiation disinfection are feasible.
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COVID-19 , Respiratory Protective Devices , COVID-19/prevention & control , Disinfection/methods , Filtration , Humans , N95 Respirators , Respiratory Aerosols and DropletsABSTRACT
As a high-density crowd collection and dispersal carrier,rail transit is characterized by airtight confinement, which will provide an suitable environment for the potential spread of coronavirus disease. The virus distribution inside stations needs to be analyzed in order to adopt effective passenger flow organization strategies to reduce the risk of virus infection inside stations. With the help of aerodynamic principle, according to the virus transmission theory, the BIM simulation technology has been used to simulate the air flow direction of a certain station of Wuhan metro using Fluent software to qualitatively analyze the station's virus-prone gathering area and provide reference for station daily disinfection.The daily passenger flow organization of the station has been simulated considering the social force model.Comparing the overlap between the concentrated area of passenger flow density and the virus-prone area,a targeted imrovement plan of passenger flow organization has been proposed. The improvement measures have been verified quantitatively by two evaluation indexes: the average dwell time and virus susceptibility in pedestrian stations. The results show the effectiveness in reducing the probability of virus infection of passengers traveling in the station by disabling the station vending machines, reducing the number of passengers in the station, increasing the escalator rate, and optimizing the flow lines of passengers entering and exiting the station. The simulation results can provide inspiration and reference for normalized epidemic prevention in the daily operation of rail transit. © 2021 IEEE
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The outbreak of COVID-19 has disrupted people's pace of life and greatly affected the normal development of industry and commerce. Different types of enterprises have experienced different degrees of losses. The e-commerce companies, which rely on both labor and information techniques, have been influenced obviously. To investigate the resilience supply chains of e-commerce companies in the post-epidemic era, we choose Jingdong (JD) as an example and identify their performances during this specific period. According to our analysis, JD has shown its strong supply chain management and service ability in the post-epidemic period of resuming work and production. Moreover, the functions of the digital technology integration system of the JD Smart Purchasing Platform are also demonstrated. It provides integrated supply chain service and procurement project service that faces those relative enterprises. In conclusion, applying the Information Visualization management system could provide an efficient reference for supply chain management of e-commerce companies. © 2021 IEEE.
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Purpose: Health-related online fake news (HOFN) has become a major social problem. HOFN can lead to the spread of ineffective and even harmful remedies. The study aims to understand Internet users' responses to HOFN during the coronavirus (COVID-19) pandemic using the protective action decision model (PADM). Design/methodology/approach: The authors collected pandemic severity data (regional number of confirmed cases) from government websites of the USA and China (Studies 1 and 2), search behavior from Google and Baidu search engines (Studies 1 and 2) and data regarding trust in two online fake news stories from two national surveys (Studies 2 and 3). All data were analyzed using a multi-level linear model. Findings: The research detected negative time-lagged relationships between pandemic severity and regional HOFN search behavior by three actual fake news stories from the USA and China (Study 1). Importantly, trust in HOFN served as a mediator in the time-lagged relationship between pandemic severity and search behavior (Study 2). Additionally, the relationship between pandemic severity and trust in HOFN varied according to individuals' perceived control (Study 3). Originality/value: The authors' results underscore the important role of PADM in understanding Internet users' trust in and search for HOFN. When people trust HOFN, they may seek more information to implement further protective actions. Importantly, it appears that trust in HOFN varies with environmental cues (regional pandemic severity) and with individuals' perceived control, providing insight into developing coping strategies during a pandemic. © 2021, Emerald Publishing Limited.
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Daniel R. Schwarz, Frederic J. Whiton Professor of English Literature at Cornell University, has been regarded as a master teacher, an influential literary critic, and a leading public intellectual. His prolific publications cover a wide variety of subjects, from Joseph Conrad, James Joyce, and Wallace Stevens to critical theory, the Holocaust, reading and teaching of literature, and New York City culture. Also, he has blogged regularly on the media and higher education for Huffington Post, and lectured all over the world, including teaching as a guest scholar at Peking University in 1993. On Behalf of Foreign Literature Studies, Zheng Li interviewed Schwarz on a series of issues, such as his humanistic and pluralistic critical approach, his philosophy of reading, the connection between modern art and modern literature, Holocaust Studies, and Jewish Studies. Schwarz sees reading as a kind of travel in which we explore how others live and think in both our own and different cultures. He believes that nothing makes clearer than the worldwide pandemic, Covid-19, that we are all united in "a community of common destiny", interdependent on one another. Finally, he expresses his gratefulness for the opportunities his life as teacher and scholar has presented and, with the lines from one of his favorite poems, C. P. Cavafy's "Ithaka", offers us a piece of advice, "Don't hurry the journey at all." © Copyright by Foreign Literature Studies. All right reserved.
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TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Babesiosis is a tick-borne illness caused by B. microti and other species and transmitted by the Ixodes tick. Acute respiratory distress syndrome (ARDS) can be a manifestation of babesiosis. CASE PRESENTATION: A 69 year old female with the past medical history of HTN, HLD and hypothyroidism who presented to hospital for 1 week of intermittent fever and generalized body aches. Patient denied any tick bites. She started to have intermittent fever around 40°C, nonproductive cough and generalized body aches, associated with night sweats, nausea, diarrhea. She took 1000mg Tylenol every 4 hours for fever and body aches for 1 week without improvement.Upon admission laboratory values were significant for hemolytic anemia (Hgb 9.4 g/dL, reticulocyte count 1.2%, LDH 4896 U/L, haptoglobin < 8mg/dL, total bilirubin 2.3 mg/dL), thrombocytopenia (platelet 38× 103/mm3) and leukopenia (WBC 2.7× 103/mm3), significantly elevated acetaminophen level (22.6), transaminitis (ALT 365 IU/L, AST 579 IU/L) and elevated INR (1.4). Blood parasite smear was positive for blood parasites (Malaria/Babesia: 9.6% RBC infected). Babesia Microti DNA RT-PCR was positive, Babesia Microti Ab (IgM) ≥ 1:320, Babesia Microti Ab (IgG) was 1:512, E. Chaffeensis Ab Ig G <1:64, E. Chaffeensis Ab Ig M <1:20, Lyme Ab Scr-Q <0.90. HIV and blood culture was negative. SARS-CoV-2 RNA was negative.Patient was admitted and received Acetylcysteine for acetaminophen toxicity, atovaquone, azithromycin, doxycycline for Babesia and borreliosis coverage. On day 2 of admission, acetaminophen level decreased to less than 10, transaminitis slowly improved. But patient developed shortness of breath, cough and hypoxia. Concerning severe babesiosis induced ARDS, chest CT angiogram was ordered and showed no evidence of pulmonary embolism but mild pulmonary interstitial edema. 2D Echo showed normal left ventricular systolic function and mild diastolic dysfunction. Patient received IV Lasix, symptoms improved and the CXR on day 6 showed pulmonary edema resolved.In the following days, patient continued to receive treatment for babesiosis, blood parasitemia cleared but Hgb decreased to 6.7 g/dL, patient received transfusion and Hgb level remained 7.9 g/dL on the day of discharge. 5 days after discharge, patient's Hgb level increased to 9 g/dL. 1 month after discharge, Hgb level increased to 12g/dL and transaminase level returned to normal. DISCUSSION: ARDS is a life-threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure. Though uncommon, tick-borne diseases could present with ARDS. Moreover, acetaminophen toxicity has also been linked to acute lung injury, making the correct diagnosis challenging. Early recognition and intervention led to a favorable outcome. CONCLUSIONS: ARDS can be an early onset manifestation after initiation of treatment for babesiosis and usually resolves with supportive treatment. REFERENCE #1: Autoimmune hemolytic anemia associated with babesiosis.Roshni Narurkar, Aleksandra Mamorska-Dyga, John C. Nelson and Delong Liu.Biomarker Research (2017) 5:14. REFERENCE #2: Yousef Nassar, Seth Richter. Babesiosis Presenting as Acute Liver Failure. Case Rep Gastroenterol 2017;11:769–773. REFERENCE #3: Boustani MR, Lepore TJ, Gelfand JA, Lazarus DS. Acute respiratory failure in patients treated for babesiosis. Am J Respir Crit Care Med. 1994 Jun;149(6):1689-91. doi: 10.1164/ajrccm.149.6.8004331.PMID: 8004331 Review. DISCLOSURES: No relevant relationships by Heather Bernstein, source=Web Response No relevant relationships by ALKA FARMER, source=Web Response No relevant relationships by CUIPING LI, source=Web Response No relevant relationships by Vinay Nakhate, source=Admin input No relevant relationships by kiritkumar parmar, source=Web Response No relevant relationships by Lin Zheng, source=Web Response