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1.
Hematol Oncol ; 2022 Aug 06.
Article in English | MEDLINE | ID: covidwho-1976711

ABSTRACT

A multicenter retrospective study was designed to assess clinical outcome of COVID-19 in patients with hematological malignancies (HM) following treatment with anti-SARS-CoV-2 convalescent plasma (CP) or standard of care therapy. To this aim, a propensity score matching was used to assess the role of non-randomized administration of CP in this high-risk cohort of patients from the Italian Hematology Alliance on COVID-19 (ITA-HEMA-COV) project, now including 2049 untreated control patients. We investigated 30- and 90-day mortality, rate of admission to intensive care unit, proportion of patients requiring mechanical ventilatory support, hospitalization time, and SARS-CoV-2 clearance in 79 CP recipients and compared results with 158 propensity score-matched controls. Results indicated a lack of efficacy of CP in the study group compared with the untreated group, thus confirming the negative results obtained from randomized studies in immunocompetent individuals with COVID-19. In conclusion, this retrospective analysis did not meet the primary and secondary end points in any category of immunocompromized patients affected by HM.

2.
Hematol Oncol ; 2022 Jul 19.
Article in English | MEDLINE | ID: covidwho-1935680

ABSTRACT

The impact of secondary infections (SI) on COVID-19 outcome in patients with hematological malignancies (HM) is scarcely documented. To evaluate incidence, clinical characteristics, and outcome of SI, we analyzed the microbiologically documented SI in a large multicenter cohort of adult HM patients with COVID-19. Among 1741 HM patients with COVID-19, 134 (7.7%) had 185 SI, with a 1-month cumulative incidence of 5%. Median time between COVID-19 diagnosis and SI was 16 days (IQR: 5-36). Acute myeloid leukemia (AML) and lymphoma/plasma cell neoplasms (PCN) were more frequent diagnoses in SI patients compared to patients without SI (AML: 14.9% vs. 7.1%; lymphoma/PCN 71.7% vs. 65.3%). Patients with SI were older (median age 70 vs. 66 years, p = 0.002), with more comorbidities (median Charlson Comorbidity Index 5 vs. 4, p < 0.001), higher frequency of critical COVID-19 (19.5% vs. 11.5%, p = 0.046), and more frequently not in complete remission (75% vs. 64.7% p = 0.024). Blood and bronchoalveolar lavage were the main sites of isolation for SI. Etiology of infections was bacterial in 80% (n = 148) of cases, mycotic in 9.7% (n = 18) and viral in 10.3% (n = 19); polymicrobial infections were observed in 24 patients (18%). Escherichia coli represented most of Gram-negative isolates (18.9%), while coagulase-negative Staphylococci were the most frequent among Gram-positive (14.2%). The 30-day mortality of patients with SI was higher when compared to patients without SI (69% vs. 15%, p < 0.001). The occurrence of SI worsened COVID-19 outcome in HM patients. Timely diagnosis and adequate management should be considered to improve their prognosis.

3.
Front Cardiovasc Med ; 7: 598846, 2020.
Article in English | MEDLINE | ID: covidwho-1067650

ABSTRACT

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation. Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I 2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I 2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I 2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I 2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I 2 0%]. Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

4.
PLoS Negl Trop Dis ; 14(11): e0008853, 2020 11.
Article in English | MEDLINE | ID: covidwho-917979

ABSTRACT

With the evolution of the Coronavirus Disease 2019 (COVID-19) pandemic, the number of patients brought to medical attention has increased. This has led to the unmasking of many coexisting occult infections and comorbidities such as tuberculosis, dengue, human immunodeficiency viral infection, diabetes, and hypertension. We report the first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, unveiling the diagnosis of asymptomatic filariasis. A 37-year-old gentleman presented with shortness of breath, fever, and cough. He was found to have COVID-19 pneumonia. During his stay, microfilaria of Wuchereria bancrofti was detected incidentally on a blood smear exam. Consequently, the patient received appropriate treatment for both conditions. In order not to miss relevant concomitant diagnoses, it is prudent to keep a broad differential diagnosis when faced with SARS-CoV-2-infected patients; this is especially true when atypical symptoms are present or in areas endemic with other infections.


Subject(s)
Coronavirus Infections/diagnosis , Filariasis/diagnosis , Pneumonia, Viral/diagnosis , Adult , Animals , Betacoronavirus , COVID-19 , Coinfection , Coronavirus Infections/parasitology , Filariasis/virology , Humans , Incidental Findings , Male , Pandemics , Pneumonia, Viral/parasitology , SARS-CoV-2 , Wuchereria bancrofti
5.
IDCases ; 21: e00895, 2020.
Article in English | MEDLINE | ID: covidwho-621608

ABSTRACT

As the cases of COVID-19 are flooding around the world, atypical presentations are being recognized, making the diagnosis challenging. Gastrointestinal symptoms and mild abdominal pain are common. However, severe abdominal pain associated with COVID-19 warranting surgical evaluation has been rarely described; recognizing such presentations and differentiating them from a surgical abdomen is critical to effectively and safely manage COVID-19 patients. Here we present a case of a middle-aged gentleman who developed features resembling secondary peritonitis. Eventually, he was found to have COVID-19 and was managed conservatively. In this report, we discuss his management course, and we explore pertinent relevant literature.

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