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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316781

ABSTRACT

Background: To date, the Corona Virus Disease-2019 (COVID-19) pandemic has resulted in more than 24,400 confirmed cases in Ireland, with more than 30% involving Healthcare Workers (HCW). As more staff become involved in the care of COVID-19 patients, many key clinical considerations remain uncertain, including the possibility of re-infection following initial illness, the clinical significance of prolonged viral shedding and the degree of protection conferred by development of anti- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibodies.We present 3 cases of COVID19-infected HCWs, each with distinct episodes of recurrent symptoms following initial resolution and with persistently positive SARS-CoV-2 PCR results, ranging up to 60 days post onset of illness. PCR results, cycle threshold (Ct) values and clinical assessment are provided to discuss the diagnostic difficulties in assessing relapsed COVID-19 infection, or re-infection with new virus following return to work. Case presentations : Patient 1,2 and 3 (age range 25-36) tested positive for SARS-CoV-2 via rtPCR on oro/nasopharyngeal swab with initial Ct values of 21.72, 24.52 and 26.58 respectively, following presentation with respiratory symptoms. All completed 14 day periods of self-isolation with full resolution of symptoms. Each patient has a clinical role and was involved in the management of COVID-19 patients following return to work. Patient 1 was admitted to hospital 44 days after initial illness, with cough, dyspnoea and a concurrent diagnosis of neurosyphilis. SARS-CoV-2 PCR was positive with Ct value 31.36 and remained positive for at least 60 days following initial illness onset. A full clinical recovery followed. Patients 2 and 3 represented to the Emergency Department with recurrent respiratory symptoms 29 and 40 days following initial illness onset respectively. SARS-CoV-2 PCR was demonstrated in each with Ct values 31.16 and 30.72 respectively. Each subsequently made a full recovery following a second period of self-isolation. Anti-SARS-CoV-2 IgG was demonstrated in all 3 patients. Conclusions: : These cases demonstrate the diagnostic difficulties in determining intermittent presentation of COVID-19 infection with prolonged viral shedding, or re-infection with new virus following return to work. As the pandemic progresses, this represents a growing diagnostic challenge impacting patient assessment, staff deployment following illness and infection control.

2.
BMJ Case Rep ; 14(12)2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1546476

ABSTRACT

We describe the case of a 30-year-old man who presented to our institution with hypoxia and widespread pulmonary infiltrates managed initially as COVID-19 before receiving a new diagnosis of HIV-associated Kaposi sarcoma (KS) with widespread pulmonary and skeletal involvement. Initial differential diagnoses included Pneumocystis jirovecii pneumonia, disseminated mycobacterial infection and bacillary angiomatosis. A bone marrow biopsy showed heavy infiltration by spindle cells, staining strongly positive for human herpes virus-8 (HHV-8) and CD34, suggesting symptomatic, disseminated KS as the unifying diagnosis. The patient commenced cytotoxic therapy with weekly paclitaxel, with a clinical and radiological response. To our knowledge, this case is among the most severe described in the literature, which we discuss, along with how COVID-19 initially hindered developing a therapeutic allegiance with the patient.


Subject(s)
COVID-19 , HIV Infections , Herpesvirus 8, Human , Sarcoma, Kaposi , Adult , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , SARS-CoV-2 , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/drug therapy
3.
JAC Antimicrob Resist ; 3(2): dlab085, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1294742

ABSTRACT

BACKGROUND: A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection. METHODS: A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups. RESULTS: In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44-76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5-10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy. CONCLUSIONS: Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.

4.
Epidemiol Infect ; 149: e157, 2021 04 27.
Article in English | MEDLINE | ID: covidwho-1203374

ABSTRACT

Hospital healthcare workers (HCWs) are at increased risk of contracting COVID-19 infection. We aimed to determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in HCWs in Ireland. Two tertiary referral hospitals in Irish cities with diverging community incidence and seroprevalence were identified; COVID-19 had been diagnosed in 10.2% and 1.8% of staff respectively by the time of the study (October 2020). All staff of both hospitals (N = 9038) were invited to participate in an online questionnaire and blood sampling for SARS-CoV-2 antibody testing. Frequencies and percentages for positive SARS-CoV-2 antibody were calculated and adjusted relative risks (aRR) for participant characteristics were calculated using multivariable regression analysis. In total, 5788 HCWs participated (64% response rate). Seroprevalence of antibodies to SARS-CoV-2 was 15% and 4.1% in hospitals 1 and 2, respectively. Thirty-nine percent of infections were previously undiagnosed. Risk for seropositivity was higher for healthcare assistants (aRR 2.0, 95% confidence interval (CI) 1.4-3.0), nurses (aRR: 1.6, 95% CI 1.1-2.2), daily exposure to patients with COVID-19 (aRR: 1.6, 95% CI 1.2-2.1), age 18-29 years (aRR: 1.4, 95% CI 1.1-1.9), living with other HCWs (aRR: 1.3, 95% CI 1.1-1.5), Asian background (aRR: 1.3, 95% CI 1.0-1.6) and male sex (aRR: 1.2, 95% CI 1.0-1.4). The HCW seroprevalence was six times higher than community seroprevalence. Risk was higher for those with close patient contact. The proportion of undiagnosed infections call for robust infection control guidance, easy access to testing and consideration of screening in asymptomatic HCWs. With emerging evidence of reduction in transmission from vaccinated individuals, the authors strongly endorse rapid vaccination of all HCWs.


Subject(s)
Antibodies, Viral/blood , COVID-19 , Personnel, Hospital/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/immunology , Cross-Sectional Studies , Female , Humans , Ireland/epidemiology , Male , Middle Aged , SARS-CoV-2/immunology , Seroepidemiologic Studies , Young Adult
5.
Int Med Case Rep J ; 14: 1-10, 2021.
Article in English | MEDLINE | ID: covidwho-1038554

ABSTRACT

When SARS-CoV-2 prevalence is low, many RT-qPCR-positive test results are false positives. Sequencing of a 398-bp cDNA PCR amplicon derived from a highly conserved segment with single nucleotide polymorphisms of the nucleocapsid (N) gene in presumptive positive samples can verify true positives and differentiate at least 27 phylogenetically distinct strains of SARS-CoV-2 for helping track virus strain movement between individuals and across geographical areas. We report using this partial N gene sequencing method to confirm a case of mild COVID-19 disease. The patient was first seen on March 15, 2020, in the emergency department of the university hospital in Dublin, Ireland. RT-qPCR test on a nasopharyngeal swab sample was positive for SARS-CoV-2. Partial sequencing of the N gene in the residue of the tested RNA extract showed a characteristic set of 3-consecutive GGG-to-AAC mutations at positions 28881, 28882, 28883, which is known to first appear in samples collected in Continental Europe in February 2020. Using this sequencing-based method to re-test 9 reference nasopharyngeal swab samples supplied by the Connecticut State Department of Public Health Microbiology Laboratory revealed that 2 of the 9 positive samples had a single nucleotide mutation in the 398-base segment of the SARS-CoV-2 N gene. One of the 2 mutant samples showed a mutation at position 28821, which was first reported in a sample recently collected in the neighboring New York state. The other sample showed a novel frameshift nucleotide "A" insertion between position 29051 and position 29057, which co-existed with its wildtype parental virus in one sample. Routine sequencing of RT-qPCR-positive samples can minimize or eliminate false-positive SARS-CoV-2 test results that may cause unnecessary anxiety among the population and prevent false-positive tests from shutting down schools and workplaces unnecessarily as businesses try to resume normal operations in the community.

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