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2.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333508

ABSTRACT

BACKGROUND: Serological tests are crucial tools for assessments of SARS-CoV-2 exposure, infection and potential immunity. Their appropriate use and interpretation require accurate assay performance data. METHOD: We conducted an evaluation of 10 lateral flow assays (LFAs) and two ELISAs to detect anti-SARS-CoV-2 antibodies. The specimen set comprised 128 plasma or serum samples from 79 symptomatic SARS-CoV-2 RT-PCR-positive individuals;108 pre-COVID-19 negative controls;and 52 recent samples from individuals who underwent respiratory viral testing but were not diagnosed with Coronavirus Disease 2019 (COVID-19). Samples were blinded and LFA results were interpreted by two independent readers, using a standardized intensity scoring system. RESULTS: Among specimens from SARS-CoV-2 RT-PCR-positive individuals, the percent seropositive increased with time interval, peaking at 81.8-100.0% in samples taken >20 days after symptom onset. Test specificity ranged from 84.3-100.0% in pre-COVID-19 specimens. Specificity was higher when weak LFA bands were considered negative, but this decreased sensitivity. IgM detection was more variable than IgG, and detection was highest when IgM and IgG results were combined. Agreement between ELISAs and LFAs ranged from 75.7-94.8%. No consistent cross-reactivity was observed. CONCLUSION: Our evaluation showed heterogeneous assay performance. Reader training is key to reliable LFA performance, and can be tailored for survey goals. Informed use of serology will require evaluations covering the full spectrum of SARS-CoV-2 infections, from asymptomatic and mild infection to severe disease, and later convalescence. Well-designed studies to elucidate the mechanisms and serological correlates of protective immunity will be crucial to guide rational clinical and public health policies.

3.
Journal of Heart & Lung Transplantation ; 41(4):S179-S179, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783397

ABSTRACT

The purpose of this study is to compare patient characteristics of those who died from Covid-19 compared to death from all other causes. The UNOS registry was queried to compare transplant recipients who died of Covid (n=300) vs non-Covid causes (n=5,644) from 2018 to 2021. Patient characteristics including age, sex, ethnicity, smoking, medical comorbidities, and time of transplant hemodynamics were evaluated. Baseline characteristics were compared using the Mann Whitney U test and Chi square test as appropriate. Survival was compared using Kaplan-Meier survival analysis. The population who died from Covid was significantly older (56.6y vs 49.8y, p <0.001), had a higher percentage of males (79.3% vs 74.3%, p=0.049), had a higher incidence of diabetes (39.1% vs 27.8%, p<0.001), increased incidence of smoking (53.7% vs 42% p<0.001), and had a higher cardiac output (4.7L/min vs 4.5L/min, p=0.032). Causians had significantly lower incidence of death from Covid (62.7% vs 67.2%, p=0.031). Donor age, waiting times, baseline renal function, ischemic times, and cardiopulmonary support time did not differ significantly between the two populations. Widely studied risk factors for Covid pneumonia mortality such as age, male sex, diabetes, and smoking were consistent in the post heart transplant population. Communities of color were disproportionately affected by Covid. Furthermore, Covid deaths were not associated with inferior cardiac characteristics at time of transplant. More investigation is warranted to investigate the effect of more widely available immunologic and pharmacological therapies on high-risk subpopulations following heart transplant. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

4.
Journal of Heart & Lung Transplantation ; 41(4):S397-S397, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783396

ABSTRACT

Select bacterial and mold infections are known risk factors for chronic allograft dysfunction (CLAD) in a subset of lung transplant recipients (LTR). Secondary bacterial (SBI) and fungal infections (SFI) have been described among people with severe influenza infection and COVID-19 requiring mechanical ventilation, but the incidence and clinical outcomes of LTR who develop secondary infections following respiratory viral infections (RVI) are not well described. We conducted a retrospective study of LTR who were diagnosed with either influenza or COVID-19 from January 2011-May 2021. Infection definitions and CLAD stage were defined according the International Society of Heart and Lung Transplantation guidelines. Fifty-seven LTR with influenza and 33 with COVID-19 were identified. Eleven (19%) of the LTR with influenza developed SBI and seven (21%) with COVID-19 developed SBI (p=0.83). Among patients who developed SBI, Pseudomonas aeruginosa was the most common isolated pathogen (44%). Five (9%) and 7 (21%) LTR developed SFI within 90 days post Influenza and COVID-19 infection, respectively (p = 0.09). Among patients with fungal infection, Aspergillus species were the most common pathogen (75%). At 180 days post RVI, all-cause mortality was higher in LTR with SBI (17%) compared to those without (3%), p=0.02. Mortality was similarly higher in LTR with SFI (33%), compared to those without (1.3%), p<0.0001. At 180 days post RVI, LTR with SBI had progression of CLAD stage 43% vs 11%, p=0.004. Based on univariable logistic regression, LTR who had augmented corticosteroids at time of RVI, and lower respiratory tract infection (LRTI) had higher risk of SFI (odds ratio (OR) of 6.57 (1.8, 23.9), p=0.002 and 12.5 (2.53, 61.7), p=0.004, respectively). There were trends of increased OR of SBI among LTR with LRTI and LTR requiring ICU admission due to RVI with the ORs of 2.78 (0.98, 8.01), p=0.06 and 3.77 (0.90, 15.84), p=0.07, respectively. Secondary bacterial and fungal infections are associated with increased all-cause mortality in LTR with influenza and COVID-19, and in the case of SBI, also associated with CLAD stage progression. LTR with LRTI and augmented steroids may be at increased risk of secondary fungal infections. Strategies to mitigate and improve diagnosis may warrant further examination. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

5.
Humanidades & Inovacao ; 8(63):224-236, 2021.
Article in Portuguese | Web of Science | ID: covidwho-1766668

ABSTRACT

This article aims to discuss the new relationships established among the main actors of teaching and learning process in remote education, imposed by the need for social isolation brought about by the arrival of Covid-19 in our country, presenting data on remote work in two schools in the municipality of Marilia-SP, one from the Municipal System and another from the State Education System. The data revealed that social inequalities in times of crisis are more accentuated, given the differences in access to the technologies used to guide the teaching-learning process. Another relevant fact was the value given by the students' family members to the teachers as fundamental actors in conducting this process, providing the students with the possibility of appropriating knowledge, and, consequently, of developing the cognitive abilities of their children and/ or tutors.

6.
Clin J Sport Med ; 32(2): 177-232, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1758906
7.
Physiotherapy (United Kingdom) ; 114:e86-e87, 2022.
Article in English | EMBASE | ID: covidwho-1707356

ABSTRACT

Keywords: Tendinopathy;Rotator cuff;Digital transformation Purpose: Similar associations between self-reported bio-psycho-social factors and the presentation of people with various shoulder disorders and rotator cuff (RC) tendinopathy have been reported;however, only limited numbers of variables have been assessed, often in small cohorts. We aimed to test whether RC tendinopathy could be distinguished from other shoulder problems using a range of bio-psycho-social self-reported factors and the degree to which they explain severity. Methods: Self-reported bio-psycho-social factors were collected via an online survey battery from an international sample. The dependent variables were diagnosis (having RC tendinopathy or other shoulder problems) and severity. After group comparison and univariate regression analyses, multivariable logistic and linear regression analyses were used to construct explanatory models for group differences and severity. Results: 82 people with RC tendinopathy (42.8 ± 13.9 years, 50 female) and 54 people with other shoulder problems (40.2 ± 14.1 years, 33 female) were recruited and found not to differ in severity on four patient-reported PROMs (Shoulder Pain and Disability Index (SPADI) = 37.3 ± 24.5 vs 33.7 ± 22.5, Western Ontario Rotator Cuff Index (WORCI) = 56.2 ± 22.0 vs 60.3 ± 22.2, Single Assessment Numeric Evaluation = 56.6 ± 25.3 vs 56.5 ± 28.7 and Patient Acceptable Symptomatic State (yes:no) 51:31 vs 23:22, respectively). Eight self-reported factors individually distinguished RC tendinopathy from other shoulder problems, with the model distinguishing tendinopathy from other shoulder problems including 4 variables;having a previous injury in the shoulder (OR (95% CI) = 0.30 (0.13–0.69)), activity effect on pain (OR (95% CI) = 2.24 (1.02–4.90)), General Self-Efficacy Score (OR (95% CI) = 1.12 (1.02–1.22)) and activity level according to Global Physical Activity Questionnaire (moderately active OR (95% CI) = 3.97 (1.29–12.18) and highly active OR (95% CI) = 3.66 (1.41–9.48)), with acceptable overall model accuracy. Univariate linear regression analysis showed that 32 variables were associated with RC tendinopathy severity with a multivariable model consisting of quality of life (β coefficient = −0.38), having night pain (β = 0.19), having unilateral morning stiffness (β = 0.25), BMI (β = 0.29), FABQ (work) score (β = 0.25);and pain catastrophising (β = 0.21) explaining 68% of the variance in severity. Conclusion(s): Well validated patient-reported outcomes to explain severity do not distinguish RC tendinopathy from other shoulder problems however self-reported bio-psycho-social factors do, so may be useful for clinical evaluation. Further, these factors were strongly associated with severity, reinforcing the potential to improve patient assessment, for example, using pre-consultation online data collection in usual care. The models warrant prospective validation and consideration alongside data from physical and imaging assessment. Impact: Online survey including self-reported bio-psycho-social factors may help augment diagnosis and, more importantly, provide some of the detail needed for holistic assessment by complementing physical examination and imaging. Therefore, the online survey may be useful to minimise the clinical time commitment and optimising safety during the Covid-19 pandemic. Funding acknowledgements: The review is a part of Mehmet Delen's Ph.D., which is sponsored by the Turkish Ministry of National Education. The sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

9.
Journal of Medical Devices, Transactions of the ASME ; 16(1), 2022.
Article in English | Scopus | ID: covidwho-1697998

ABSTRACT

Ventilator sharing has been proposed as a method of increasing ventilator capacity during instances of critical shortage. We sought to assess the ability of a regulated, shared ventilator system, the multisplit ventilator system, to individualize support to multiple simulated patients using one ventilator. We employed simulated patients of varying size, compliance, minute ventilation requirement, and positive end-expiratory pressure (PEEP) requirement. Performance tests were performed to assess the ability of the system, versus control, to achieve individualized respiratory goals to clinically disparate patients sharing a single ventilator following ARDSNet guidelines (Acute Respiratory Distress Syndrome). Resilience tests measured the effects of simulated adverse events occurring to one patient on another patient sharing a single ventilator. The multisplit ventilator system met individual oxygenation and ventilation requirements for multiple simulated patients with a tolerance similar to that of a single ventilator. Abrupt endotracheal tube occlusion or extubation occurring to one patient resulted in modest, clinically tolerable changes in ventilation parameters for the remaining patients. The proof-of-concept ventilator system presented in this paper is a regulated, shared ventilator system capable of individualizing ventilatory support to clinically dissimilar simulated patients. It is resilient to common adverse events and represents a feasible option to ventilate multiple patients during a severe ventilator shortage. Copyright © 2022 by ASME.

10.
Journal of Studies on Alcohol and Drugs ; 82(6):808-809, 2021.
Article in English | Web of Science | ID: covidwho-1688271
11.
Environ Sci Technol ; 56(2): 1125-1137, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1607160

ABSTRACT

Some infectious diseases, including COVID-19, can undergo airborne transmission. This may happen at close proximity, but as time indoors increases, infections can occur in shared room air despite distancing. We propose two indicators of infection risk for this situation, that is, relative risk parameter (Hr) and risk parameter (H). They combine the key factors that control airborne disease transmission indoors: virus-containing aerosol generation rate, breathing flow rate, masking and its quality, ventilation and aerosol-removal rates, number of occupants, and duration of exposure. COVID-19 outbreaks show a clear trend that is consistent with airborne infection and enable recommendations to minimize transmission risk. Transmission in typical prepandemic indoor spaces is highly sensitive to mitigation efforts. Previous outbreaks of measles, influenza, and tuberculosis were also assessed. Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at higher risk parameter values. Because both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission. It is important that future outbreak reports include information on masking, ventilation and aerosol-removal rates, number of occupants, and duration of exposure, to investigate airborne transmission.


Subject(s)
Air Pollution, Indoor , COVID-19 , Aerosols , Disease Outbreaks , Humans , SARS-CoV-2 , Ventilation
12.
Archives of Clinical Neuropsychology ; 36(4):643-643, 2021.
Article in English | Web of Science | ID: covidwho-1585155
13.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-296906

ABSTRACT

We evaluated the performance of the Abbott BinaxNOW TM Covid-19 rapid antigen test to detect virus among persons, regardless of symptoms, at a public plaza site of ongoing community transmission. Titration with cultured clinical SARS-CoV-2 yielded a human observable threshold between 1.6x104-4.3x104 viral RNA copies (cycle threshold (Ct) of 30.3-28.8 in this assay). Among 878 subjects tested, 3% (26/878) were positive by RT-PCR, of which 15/26 had a Ct<30, indicating high viral load. 40% (6/15) of Ct<30 were asymptomatic. Using this Ct<30 threshold for Binax-CoV2 evaluation, the sensitivity of the Binax-CoV2 was 93.3% (14/15), 95% CI: 68.1-99.8%, and the specificity was 99.9% (855/856), 95% CI: 99.4-99.9%.

14.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-296875

ABSTRACT

We report very low SARS-CoV-2 seroprevalence in two San Francisco Bay Area populations. Seropositivity was 0.26% in 387 hospitalized patients admitted for non-respiratory indications and 0.1% in 1,000 blood donors. We additionally describe the longitudinal dynamics of immunoglobulin-G, immunoglobulin-M, and in vitro neutralizing antibody titers in COVID-19 patients. Neutralizing antibodies rise in tandem with immunoglobulin levels following symptom onset, exhibiting median time to seroconversion within one day of each other, and there is >93% positive percent agreement between detection of immunoglobulin-G and neutralizing titers.

15.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-295710

ABSTRACT

Some infectious diseases, including COVID-19, can be transmitted via aerosols that are emitted by an infectious person and inhaled by susceptible individuals. Most airborne transmission occurs at close proximity and is effectively reduced by physical distancing, but as time indoors increases, infections occur in those sharing room air despite maintaining distancing. There have been calls for quantified models to estimate the absolute and relative contribution of these different factors to infection risk. We propose two indicators of infection risk for this situation, i.e., relative risk parameter (H r ) and risk parameter (H). They combine the key factors that control airborne disease transmission indoors: virus-containing aerosol generation rate, breathing flow rate, masking and its quality, ventilation and particulate air cleaning rates, number of occupants, and duration of exposure. COVID-19 outbreaks show a clear trend in relation to these factors that is consistent with airborne infection The observed trends of outbreak size (attack rate) vs. H (H r ) allow us to recommend values of these parameters to minimize COVID-19 indoor infection risk. Transmission in typical pre-pandemic indoor spaces is highly sensitive to mitigation efforts. Previous outbreaks of measles, flu, and tuberculosis were assessed along with recently reported COVID-19 outbreaks. Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at much higher risk parameter values. Since both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission. It is important that future outbreak reports include information on the nature and type of masking, ventilation and particulate-air cleaning rates, number of occupants, and duration of exposure, to allow us to understand the circumstances conducive to airborne transmission of different diseases. Synopsis We propose two infection risk indicators for indoor spaces and apply them to COVID-19 outbreaks analysis and mitigation.

16.
Developmental Medicine and Child Neurology ; 63(SUPPL 3):70-71, 2021.
Article in English | EMBASE | ID: covidwho-1518023

ABSTRACT

Background and Objective(s): Coronavirus disease-2019 (COVID-19) led to the suspension of in-person therapy sessions in March 2020 in British Columbia (BC), Canada. This necessitated the use of virtual visits, defined as face-to-face consultation completed remotely. Here we report the assessment of pediatric physical therapists and occupational therapists use of virtual visits, barriers to virtual care, and their perceived impact on completion of community-based hip surveillance during the COVID-19 pandemic. Study Design: Cross-sectional survey. Study Participants & Setting: All pediatric therapists in the province were invited to participate. The survey was emailed to approximately 130 therapists in June 2020 using known email distribution lists. Therapists were asked to forward the survey to colleagues. Materials/Methods: An anonymous online survey assessing therapists' knowledge and learning needs related to hip surveillance was completed as part of continuous quality improvement for the Child Health BC Hip Surveillance Program for Children with Cerebral Palsy. Questions related to the provision of virtual visits during the COVID-19 pandemic were included in this survey. Therapists were also asked to rate their confidence and satisfaction in using virtual visits, identify barriers to virtual visits, and the impact of virtual visits on completing community based hip surveillance. Results: The survey was completed by 64 participants (60 physical therapists, 1 occupational therapist, 3 duel trained). Respondents were from varied practice settings: 48% metro, 30% urban, 19% rural and 3% remote. Prior to the pandemic, 6% (4) of respondents reported using virtual health with 5% (3) reporting being very confident and 22% (14) confident in using healthcare technology. Since the start of the pandemic, 86% (55) of therapists have been providing virtual visits. Eight different platforms for these visits were identified. Of those providing virtual visits, 44% were satisfied/very satisfied with their experience in providing virtual care. Barriers to providing virtual care included families not being familiar with the virtual platforms (35), not wanting to be seen virtually (34), or being able to afford technology (26) and lack of wireless internet or poor connection (19). Additionally, therapists identified completing a physical assessment (12), privacy and security concerns (9), engaging the child and family (6), and their own learning needs related to using virtual care (3) as barriers. When asked how the pandemic would affect their practice related to hip surveillance, 65% (40) reported completion of the clinical exam would be affected while 25% (16) felt identifying children that require surveillance would be impacted. The most requested resources to support virtual visits were improved access to virtual platforms and online technology tools. Conclusions/Significance: Therapists rapidly switched to using virtual healthcare due to the COVID-19 pandemic. Less than half were satisfied with their experience. Reported barriers to virtual care suggest virtual visits are not always easily accessible for families. Practical tools and strategies to facilitate access to continuing care are required when virtual visits are required.

17.
Journal of Studies on Alcohol & Drugs ; 82(6):808-809, 2021.
Article in English | MEDLINE | ID: covidwho-1507425
18.
Palliative Medicine ; 35(1 SUPPL):105, 2021.
Article in English | EMBASE | ID: covidwho-1477090

ABSTRACT

Introduction: The COVID-19 pandemic increased the volume of critically ill patients in hospital. Healthcare professionals (HCPs), many of whom had limited experience of communicating bad news to relatives, needed to be able to do this and often by telephone. Aim: To design, deliver and evaluate a simulation based course to help HCPs communicate about death and dying by telephone during the pandemic. Methods: In March 2020 a multi-professional group of clinicians and educators developed a 2-hour, socially distanced communication skills course for HCPs in our Trust. Courses ran through March-June 2020, each course facilitated by 3-5 faculty. The course taught the 'SPIKES' structure for breaking bad news (BBN), using it to critique a pre-recorded conversation and role play of simulated scenarios, with faculty feedback. Participant confidence (using 1-5 scale) was assessed by pre and post course questionnaire, and analysed by descriptive statistics. Qualitative feedback was from participant questionnaires and thematic analysis of a faculty focus group. Ethical approval was gained. Results: 79 HCPs attended a course;55 gave feedback: nurses (24), doctors (21), allied health professionals (10). There was significant improvement in participant confidence in having a communication structure for BBN (mean change 1.69 (CI 1.94,1.44), p=0.03);applying SPIKES to BBN by telephone (mean change 1.82 (CI 2.05,1.59), p=0.005);giving and seeking feedback to improve communication (mean change 1.55 (CI 1.79,1.3), p=0.012). Qualitative data indicated excellent engagement and relevance beyond the pandemic. A faculty focus group identified key themes: applicability post COVID-19, greater openness to communication challenges, and awareness of emotionality in practice. Conclusion: An innovative course developed during the COVID-19 pandemic demonstrated improved HCP confidence in communicating bad news. Skills taught are applicable post pandemic and will inform further course development.

19.
Chest ; 160(4):A309-A310, 2021.
Article in English | EMBASE | ID: covidwho-1458113

ABSTRACT

TOPIC: Chest Infections TYPE: Global Case Reports INTRODUCTION: COVID-19 is still an emerging topic and co-existence in HIV patients presents its unique challenge. These patients can range from elite controllers to Acquired immunodeficiency syndrome (T cell CD4 < 200). Throughout our management, we noticed certain trends in our population. Those patients with CD4 T cell < 200 were rarely admitted to hospital with severe cases of COVID-19, requiring if anything minimal oxygen requirements. However, HIV patients who were admitted did not fare well after initiating their anti-retroviral therapy (ART) therapy during index hospitalization. We describe two such cases one in which ART was maintained and one in which ART was help with different outcomes. CASE PRESENTATION: Both patients on admission were admitted for progressive dyspnea with COVID PCR positive, started on ART therapy, given a 10-day course of Dexamethasone 6mg and 5 doses of Remdisivir.Case 1 - 55year old Hispanic male with a history of non-compliance on Triumeq (CD4 count of 34), lymphoma in remission after chemotherapy, and sulfa allergy. On admission he was started on Triumeq, Azithromycin, Clindamycin, Primaquine. Over next 3 days he experienced progressive hypoxia and worsening chest imaging eventually requiring mechanical ventilation.Case 2 - 66year old female non-compliant on ART, and polysubstance abuse. She was also noted to have MSSA pneumonia. She was started on Emricitabine, Tenofovir, Ritonavir, and Atazanorvir. Within 48 hours of ART initiation her oxygen requirement increased. At this time, her antiretrovirals were stopped and started on Solumedrol 40mg twice daily for suspected IRIS. Her respiratory status improved and her oxygen requirements were back to baseline. Upon restarting ART 2 weeks post treatment for IRIS, patient again required an increase in oxygen supplementation. ART was held for an extended period while maintaining opportunistic infection prophylaxis. DISCUSSION: We pose this discussion for the community, as COVID-19 pathophysiology has been hypothesized to be an inflammatory response mitigated by Interleukins and Interferon-gamma, released by CD4 and CD8 T cells {3} Theoretically those with lower CD4 T cells, such as those with AIDs, should produce a lesser inflammatory response;and therefore, be less symptomatic. IRIS is typically determined from clinical context and is seen more frequently in those with CD4 < 100. {1} Treatment is typically steroids with a prolonged taper, with an ongoing discussion on whether ART should be held. {4} CONCLUSIONS: Currently there are no guidelines regarding utilization of ART in HIV patients infected with COVID;which leads to following questions of whether ART be held transiently until the COVID-19 pneumonia has been sufficiently treated? When should ART be restarted in these patients? If a patient's condition is deteriorating, should the patient's ART be held and started on opportunistic infection prophylaxis? REFERENCE #1: Bosamiya, S.S. The immune reconstitution inflammatory syndrome (2011) 56(5) 476-9, Indian J Dermatology. doi : 10.4103/0019-5154.87114 REFERENCE #2: Brown, L.B, Spinelli, M.A., and Gandhi, M. The interplay between HIV and COVID-19: summary of the data and responses to date. (2021) 16(1) 63-73, Current opinion of HIV and AIDs. REFERENCE #3: Kalfaoglu, B., Almeida-Santos, J., Tye, C.A., Satou, Y., and Ono, M. T cell dysregulation in COVID-19 (2020) 29(530) 204-210, Biochem Biophys Res Commun. doi: 10.1016/j.bbrc.2020.10.079 DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response no disclosure on file for Anjali Bakshi;No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Steven Miller, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose Orsini, source=Web Response No relevant relationships by Gaurav Parhar, source=We Response no disclosure on file for Dhruv Patel;No relevant relationships by Jason Ravidas, source=Web Response No relevant relationships by jad sargi, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by Kiran Zaman, source=Web Response No relevant relationships by John Zeibeq, source=Web Response

20.
Chest ; 160(4):A650-A651, 2021.
Article in English | EMBASE | ID: covidwho-1458112

ABSTRACT

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Pseudallescheria boydii is a fungal organism isolated from agricultural soil and polluted water. Pseudallescheria boydii (P. boydii) can rarely cause an invasive disease which is primarily seen in organ transplant patients.1 It is unusual for it to cause a pulmonary infection.1 We present a case of a patient admitted with COVID-19 who was found to be infected with P. boydii. CASE PRESENTATION: A 58-year-old male with a history of heart failure, deep venous thrombosis, stroke was admitted for altered mental status in the setting of sepsis. On admission he complained of dry cough and weakness. Lab findings were significant for lymphopenia, elevated inflammatory makers, anemia, and thrombocytopenia. Chest imaging was suspicious for COVID pneumonia;however, initial COVID-19 PCR was negative. He was started on steroids for suspected COVID pneumonia. 72 hours later there was a significant decline in his mental and respiratory status, requiring mechanical ventilation. A bronchoscopy with bronchoalveolar lavage (BAL) was performed with worsening interstitial infiltrates on chest x-ray and high index of suspicion for a fungal cause of his pulmonary insult. COVID 19 PCR was repeated, which was later found to be positive. Neurological workup with CT head, lumbar puncture and EEG were negative. We were concerned about COVID-19 encephalopathy. He was maintained on steroids for concern of organizing pneumonia. Repeat chest imaging was impressive for cavitary lesion. BAL culture sent earlier was growing a mold prompting utilization of voriconazole for concern of invasive aspergillosis. Final cultures from BAL revealed P. boydii, and he was switched to isavuconazole due to QTc prolongation. Post treatment repeat cultures were negative. DISCUSSION: Pseudallescheria boydiis is commonly seen in immunocompromised patients such as solid organ transplants. Clinical and histological features of P. boydiis and invasive aspergillosis are similar and can be difficult to distinguish in clinical practice. Optimal treatment for this infection has yet to be elucidated due to multiple resistance patterns to drugs such as amphotericin B. Studies have shown that combinations or high dose antifungals have higher success rates for treatment, but there is no regimen that is universally agreed upon.2 Based on literature review this is the first case of P.boydii pneumonia in a COVID-19 patient successfully treated with isavuconazole. CONCLUSIONS: Incidence of P.boydii is rare even in the transplant population and extremely rare to cause pulmonary infection. Additional studies must be done to better understand the pathogenesis and treatment of P. boydii to improve patient outcomes due to its severe morbidity and mortality. Based upon literature review this is the first successfully treated case of P.boydii by Isavuconazole. REFERENCE #1: Bibashi, E et al. "Invasive infection caused by Pseudallescheria boydii in an immunocompetent patient." Hippokratia vol. 13,3 (2009): 184-6. REFERENCE #2: Lackner M, de Hoog GS, Verweij PE, Najafzadeh MJ, Curfs-Breuker I, Klaassen CH, Meis JF. Species-specific antifungal susceptibility patterns of Scedosporium and Pseudallescheria species. Antimicrob Agents Chemother. 2012 May;56(5):2635-42. doi: 10.1128/AAC.05910-11. Epub 2012 Jan 30. PMID: 22290955;PMCID: PMC3346635. DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response No relevant relationships by Joanna DeAngelis, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Tania Ghorban Azar, source=Web Response No relevant relationships by Ryan Kowalsky, source=Web Response No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Steven Miller, source=Web Response No relevant relationships by Karina Muzykovsky, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose O sini, source=Web Response No relevant relationships by Gaurav Parhar, source=Web Response No relevant relationships by Evgeny Pinelis, source=Web Response Speaker/Speaker's Bureau relationship with Allergan Please note: $20001 - $100000 by Joshua Rosenberg, source=Web Response, value=Honoraria No relevant relationships by jad sargi, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by Kiran Zaman, source=Web Response

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