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1.
Blood Purification ; 50(SUPPL 1):3, 2021.
Article in English | EMBASE | ID: covidwho-1816957

ABSTRACT

Background: The COVID-19 disease was first reported in December 2019 and has since spread rapidly around the world. This disease manifests in most cases as a lower respiratory tract infection. COVID-19 enters the human body using angiotensin-converting enzyme 2, abundant in the epithelial cells of the renal tubule. Theoretically, this could be significant in many ways: acute kidney injury (AKI), as well as proteinuria, and/or microhematuria could be associated with penetration of the virus into cells. Microalbuminuria is widely recognized as a critical diagnostic tool in the progression of kidney disease. It is increased in tubular and glomerular diseases. The use of microalbuminuria as a marker for AKI was shown in an animal model and correlated with other markers. However, there are few studies that have validated its usefulness as a marker for AKI. NGAL is abundantly expressed in the kidney after renal ischemia. NGAL has been tested in multiple studies of patients at risk of acute kidney injury (AKI) due to sepsis, cardiac surgery, exposure to contrast media, or after kidney transplantation. The most frequently reported causes of admission to the intensive care unit in patients with COVID-19 are hypoxemic respiratory failure that requires invasive mechanical ventilation or hypotension that requires support with vasoactive amines. Data on AKI are scarce since they only report on incidence in these patients. Methods: A prospective observational study. Patients who came to the area for COVID-19 were recruited. Upon admission, a urine sample was analyzed with Getein 1100, by quantitative immunofluorescence to determine levels of microalbuminuria and NGAL in 50 patients with creatinine <1.0. All patients had high oxygen requirements (> 5 liters/minute). All patients who had a positive PCR test for SARS CoV-2 were included and patients with a history of chronic kidney disease, urinary symptoms, underlying urological disease or complications of Diabetes or hypertension were excluded. Laboratories were collected at admission and 5 days after admission to compare with initial Ngal and microalbuminuria levels. Results: The association of the variables was analyzed using the Spearman correlation coefficient, since they are continuous variables. It was found that an elevation of creatinine at day 5 and an initial Ngal> 200 and microalbuminuria >30 have a moderate correlation (rho = 0.46) with a p <0.05, and a low correlation (rho = 0.28) and a p <0.05, respectively. Conclusion: Although there is no ideal biomarker for acute kidney injury, current biomarkers can significantly predict the development of acute kidney injury, especially in critically ill patients. With the emergence of COVID-19 disease, it is necessary to be able to prevent and treat acute kidney injury on time, in order to reduce the morbidity and mortality of these patients. In this study, it is observed that 2 biomarkers have a significant correlation to predict acute kidney injury, and it is necessary to have more availability of these biomarkers to detect it on time.

2.
Respirology ; 27(SUPPL 1):179, 2022.
Article in English | EMBASE | ID: covidwho-1816641

ABSTRACT

Introduction: COVID-19 lockdown measures implemented in March 2020 markedly reduced hospitalisations of infants with respiratory infections at Kidz First Hospital. There was no characteristic winter peak of respiratory infections with only three hospitalisations during 1 March-31 August with a positive PCR result for RSV and one for influenza. The commencement of quarantine-free travel between Australia and New Zealand started in April 2021 and within 2 weeks there was a positive PCR panel for RSV at Kidz First, the first RSV positive test for over a year with case numbers steadily increasing thereafter. Methods: To confirm the return of the winter peak we examined respiratory viral PCR test results and infant lower respiratory tract infection (LRTI) hospitalization data from 1 January 2015, through 31 July 2021. All specimens submitted by Kidz First clinicians for respiratory viral PCR testing were identified. ICD codes were used to identify infants <2 years of age hospitalized for >3 h with a LRTI. Results: During the months of March-July the number of inpatient hospitalisations at Kidz First varied from 944 in 2015 to 706 in 2018. There was a dramatic reduction to 144 hospitalisations in 2020 but this has rebounded back to 730 in 2021. The number of positive PCR panels for RSV increased to 803(52%) with a much higher percentage than any previous year. There were no PCR positive tests for influenza A or B. The percentage of positive PCR panels for adenovirus (7%), parainfluenza (4%) and rhinovirus/ enterovirus (53%) have remained similar to previous years. Clinician-directed investigation of infants with respiratory infections has increased in response to COVID-19. Conclusion: Easing of COVID-19 restrictions and commencement of quarantine-free travel with Australia has likely resulted in the return of RSV and LRTI hospitalisations rates similar to previous winter peaks.

3.
Clinical Case Reports ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1813474

ABSTRACT

We report the case of a 51-year-old Caucasian woman who developed a pulmonary embolism in the absence of any pre-existing risk factors for VTE, 3 weeks following clozapine initiation for treatment resistant paranoid schizophrenia. She was initially misdiagnosed and treated for suspected COVID-19 infection.

4.
South African Medical Journal ; 112(4):279-287, 2022.
Article in English | EMBASE | ID: covidwho-1798764

ABSTRACT

Background. Major causes of under-5 child deaths in South Africa (SA) are well recognised, and child mortality rates are falling. The focus of child health is therefore shifting from survival to disease prevention and thriving, but local data on the non-fatal disease burden are limited. Furthermore, COVID-19 has affected children's health and wellbeing, both directly and indirectly. Objectives. To describe the pattern of disease on admission of children at different levels of care, and assess whether this has been affected by COVID-19. Methods. Retrospective reviews of children's admission and discharge registers were conducted for all general hospitals in iLembe and uMgungundlovu districts in KwaZulu-Natal Province, SA, from January 2018 to September 2020. The Global Burden of Disease framework was adapted to create a data capture sheet with four broad diagnostic categories and 37 specific cause categories. Monthly admission numbers were recorded per cause category, and basic descriptive analysis was completed in Microsoft Excel. Results. Overall, 36 288 admissions were recorded across 18 hospital wards, 32.0% at district, 49.8% at regional and 18.2% at tertiary level. Communicable diseases, perinatal conditions and nutritional deficiencies (CPNs) accounted for 37.4% of admissions, non-communicable diseases (NCDs) for 43.5% and injuries for 17.1%. The distribution of broad diagnostic categories varied across levels of care, with CPNs being more common at district level and NCDs more common at regional and tertiary levels. Unintentional injuries represented the most common cause category (16.6%), ahead of lower respiratory tract infections (16.1%), neurological conditions (13.6%) and diarrhoeal disease (8.4%). The start of the local COVID-19 outbreak coincided with a 43.1% decline in the mean number of monthly admissions. Admissions due to neonatal conditions and intentional injuries remained constant during the COVID-19 outbreak, while those due to other disease groups (particularly respiratory infections) declined. Conclusions. Our study confirms previous concerns around a high burden of childhood injuries in our context. Continued efforts are needed to prevent and treat traditional neonatal and childhood illnesses. Concurrently, the management of NCDs should be prioritised, and evidence-based strategies are sorely needed to address the high injury burden in SA.

5.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793901

ABSTRACT

Introduction: This study evaluated the usefulness and cost-effectiveness of procalcitonin (PCT) following its introduction to aid antibiotics discontinuation in critical care patients admitted to ESHT during the COVID-19 pandemic. Methods: Non-surgical critical care patients with a diagnosis of sepsis or lower respiratory tract infection during their admission between 01st January and 30th June 2020. Retrospective analysis of data using ICCA (IntelliSpace Critical Care and Anaesthesia) to compare the number of antibiotic doses administered per patient before and after introduction of PCT. After PCT introduction, we recorded the number of PCT levels requested, their frequency as well as the level of PCT and when discontinuation occurred. Results: A total of 81 patients were included-13 admitted before PCT introduction and 68 after (this important increase in the number of patients is explained by the increased proportion of patients with COVID-19 pneumonitis). The average dose of antibiotics administered per patient was reduced by 28.8% (70.24 vs 49.98) following introduction of PCT. Despite an incurred cost of £12 per PCT assay, the overall average cost per patient was reduced by £59.60 (£257.94 vs £146.78). A lack of consistency in the frequency of PCT level request was observed. Conclusions: Introduction of PCT to aid discontinuation of antibiotics resulted in a 28.8% reduction in average antibiotics prescription and an overall cost reduction of £59.60 per patient. The reduction in antibacterial exposure also brings non-financial benefits such as increased patient safety through experience of less side-effects, reduction in antibiotics resistance among others. The lack of consistency in the requests of PCT resulted in the design of a protocol for its use within ESHT.

6.
Transpl Infect Dis ; 24(1): e13725, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1794555

ABSTRACT

BACKGROUND: Lower respiratory tract infections (LRTIs) are a significant cause of morbidity and mortality in lung transplant (LTx) recipients. Timely and precise pathogen detection is vital to successful treatment. Multiplex PCR kits with short turnover times like the BioFire Pneumonia Plus (BFPPp) (manufactured by bioMérieux) may be a valuable addition to conventional tests. METHODS: We performed a prospective observational cohort study in 60 LTx recipients with suspected LRTI. All patients received BFPPp testing of bronchoalveolar lavage fluid in addition to conventional tests including microbiological cultures and conventional diagnostics for respiratory viruses. Primary outcome was time-to-test-result; secondary outcomes included time-to-clinical-decision and BFPPp test accuracy compared to conventional tests. RESULTS: BFPPp provided results faster than conventional tests (2.3 h [2-2.8] vs. 23.4 h [21-62], p < 0.001), allowing for faster clinical decisions (2.8 [2.2-44] vs. virology 28.1 h [23.1-70.6] and microbiology 32.6 h [4.6-70.9], both p < 0.001). Based on all available diagnostic modalities, 26 (43%) patients were diagnosed with viral LRTI, nine (15 %) with non-viral LRTI, and five (8 %) with combined viral and non-viral LRTI. These diagnoses were established by BFPPp in 92%, 78%, and 100%, respectively. The remaining 20 patients (33 %) received a diagnosis other than LRTI. Preliminary therapies based on BFPPp results were upheld in 90% of cases. There were six treatment modifications based on pathogen-isolation by conventional testing missed by BFPPp, including three due to fungal pathogens not covered by the BFPPp. CONCLUSION: BFPPp offered faster test results compared to conventional tests with good concordance. The absence of fungal pathogens from the panel is a potential weakness in a severely immunosuppressed population.


Subject(s)
Lung Transplantation , Pneumonia , Respiratory Tract Infections , Clinical Decision-Making , Humans , Lung Transplantation/adverse effects , Prospective Studies , Respiratory Tract Infections/diagnosis
7.
Bulletin of the National Research Centre ; 46(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1789150

ABSTRACT

BackgroundViral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children.ResultsThis prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza–3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus.ConclusionsViral infection is prevalent in the childhood period;however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses.

8.
Access Microbiol ; 4(2): 000311, 2022.
Article in English | MEDLINE | ID: covidwho-1769467

ABSTRACT

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues, other previously ignored viruses must be taken into account as causes of severe acute respiratory distress, influenza-like illness and pneumonia. In this article, we report two cases of pneumonia in chronic liver disease patients where human coronavirus (HCoV) 229E was identified as the only infecting pathogen. Both the patients presented with fever, cough and respiratory distress, along with radiological findings suggestive of pneumonia. Multiplex real-time PCR for various respiratory viruses (FilmArray Respiratory Panel 2 plus) detected HCoV-229E in both cases. Both cases were managed with prophylactic antibiotics, steroids and supplemental oxygen therapy, after which they recovered completely and were discharged.

9.
Open Forum Infectious Diseases ; 8(SUPPL 1):S147-S148, 2021.
Article in English | EMBASE | ID: covidwho-1746747

ABSTRACT

Background. Following updates to IDSA guidelines in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods. This was a multi-center, quasi-experimental, retrospective study of patients with CAP from 9/1/19 to 10/31/19 (pre-intervention) and 9/1/20 to 10/31/20 (post-intervention). Patients were identified using ICD-10 codes indicating lower respiratory tract infection and excluded if had a positive SARS-COV-2 PCR during admission. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results. A total of 331 and 352 patients were included in the pre- and post-intervention groups, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period (p< 0.001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs. [190/312] 60.9%;p = 0.003). There were no differences in order set usage (10% vs. 11.3%, p = 0.642) between the pre- and post-intervention groups, respectively. Hospital LOS was lower in the post-intervention cohort (4.8 days [2.9-7.2 days] vs. 5.3 days [IQR 3.5-8.5 days], p = .002). Conclusion. Despite low utilization of the order-set, education surrounding order-set changes appeared to improve antibiotic prescribing and hospital LOS in our population. Further opportunities to improve order-set use and thus further increase guideline-concordant therapy are still available.

10.
Open Forum Infectious Diseases ; 8(SUPPL 1):S256, 2021.
Article in English | EMBASE | ID: covidwho-1746694

ABSTRACT

Background. Since the onset of the 2019 coronavirus disease 2019 (COVID-19) pandemic, the rapid increase in community-acquired pneumonia (CAP) cases has led to an excessive rate of intensive care units (ICU) admissions, a rate varying between 5-18%, depending on the country. Consequently, the study of serum biomarkers, such as D-dimer, have been utilized to identify patient with severe disease. However, further data is needed to confirm the association between this serum concentration of D-dimer and the risk of ICU admission. Thus, the aim of this study was to determine if serum concentration of D-dimer predict the risk of ICU admission in patients with COVID-19 and CAP. Methods. A prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years old, hospitalized for COVID-19 or CAP were included. Then, patients were stratified into ICU and non-ICU patients. Plasma samples were collected within the first 24 hours of hospital admission to quantify D-dimer using the PATHFAST system. Concentrations were compared among groups and to assess the biomarker capacity to predict ICU admission risk, ROC curves were used. Finally, a DeLong test was applied to compare their differences. Results. A total of 240 patients diagnosed with lower respiratory tract infection were included in the study. 88 patients were COVID-19 negative (CAP) and 152 were positive. Plasma concentrations of D-dimer (μg/ml) were significantly higher in COVID-19 patients admitted to the ICU when compared with non-ICU COVID-19 admitted patients (Median [IQR];1.54 [0.9-3.25] Vs. 1.13 [0.69-1.69], p=0.005). The area under curve (AUC) ROC to predict ICU admission was 0.62 among COVID-19 patients. DeLong's test p value was 0.24. Serum D-dimer an ICU admission Conclusion. D-dimer seems to be a promising tool to identify COVID-19 patients with disease. However, this predicting capacity was not observed in CAP patients. Further studies are needed to identify the mechanisms underling the elevation of D-dimer in COVID-19 patients.

11.
Open Forum Infectious Diseases ; 8(SUPPL 1):S304-S305, 2021.
Article in English | EMBASE | ID: covidwho-1746588

ABSTRACT

Background. The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. COVID-19 causes lower respiratory tract infection (LRTI) and hypoxia. There is a paucity of data on bacterial and fungal coinfection rates in patients with COVID-19 at low and middle income countries (LMICs). Our objective is to describe the clinical characteristics of critically ill patients with COVID-19 in the Dominican Republic (DR) Methods. We performed a retrospective review of patients admitted to the ICU with COVID-19 from March 14th to December 31st 2020, at a 296-bed tertiary care level and teaching Hospital in the Dominican Republic. Demographic and clinical information was collected and tabulated. Laboratory confirmed bacterial and fungal infections were defined as community acquired infections (CAI) if diagnosed within 48 hours of admission and hospital acquired infections (HAI) when beyond 48 hours. Microbiologic data was tabulated by source and attribution. Results. Our cohort had 382 COVID-19 patients. Median age was 64 and most were male (64.3%) and 119 (31.1%) were mechanically ventilated and 200 (52%) had central venous catheters. A total of 28 (7%) laboratory confirmed community acquired infections and 55 (14%) HAIs occurred. Community acquired infections included 13 (46%) bloodstream infections (BSIs), 11 (39%) urinary tract infections (UTI) and 6 (21%) LRTIs. HAIs included 39 (70%) BSIs, 11 (20%) UTIs and 6 (11%) ventilator associated pneumonias (VAP). Causal organisms of community and hospital acquired BSI and UTI are in Figure 1 and Figure 2 respecively. All-cause mortality was 35.3% (135/382) in our cohort, and 100% mortality (76) in those with coinfections. Conclusion. Community and hospital acquired infections were common and in the ICU and likely contributed to patient outcomes. More than two thirds of HAIs in the ICU were BSIs. Central venous catheter device utlization and maintenance may play a role in BSIs, along with immunosuppression from COVID-19 therapeutics and translocation from mucosal barrier injury. Mortality in patients with coinfections was higher than those without. Infection prevention strategies to reduce device utilization during COIVD-19 in LMICs may have an impact on HAIs.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S331, 2021.
Article in English | EMBASE | ID: covidwho-1746539

ABSTRACT

Background. Up until this day, over 3.5 million fatalities related to coronavirus disease 2019 (COVID-19) have been registered worldwide by the World Health Organization. Healthcare professionals require prognostic tools for COVID-19 patients in order to guide treatment strategies. Elevated troponin levels, a biomarker of cardiac injury, have been detected among patients with COVID-19, hence associating it with cardiac injury. Although several studies have mentioned it, the role of troponin as a prognosis biomarker is unclear. Elevation in troponin levels has been observed in patients with community-acquired pneumonia (CAP). However, its association with mortality is scarcely mentioned in literature. Thus, we sought to determine the utility of serum troponin I levels as a mortality predictor for patients with COVID-19 and CAP. Methods. A prospective observational study was carried out at Clinica Universidad de La Sabana, Colombia, with patients hospitalized due to CAP and COVID-19. Troponin biomarker was quantified in serum samples using the PATHFAST system within the first 24 hours of hospital admission. Serum concentrations of troponin were compared among study groups. To assess the biomarkeŕs capacity to predict mortality, ROC curves were used, quantifying their differences through the DeLonǵs test. Results. A total of 88 patients with CAP and 152 with COVID-19 were included in the study. In all cohort the median [IQR] serum concentration of troponin (ng/ml) was higher in those who died (34.2, [9.74-384] vs 5.89, [2.44-27.9] p< 0.001). Furthermore, troponin was higher in deceased patients with COVID-19 vs those who survived (77.35 [11.9-346.5] vs. 4.88 [2.10-13.02], p< 0.001). However, there was no significant difference between CAP deceased and not deceased patients (18.1 [8.52-398] vs 15.7 [3.75-62.8], p=0.16). Although sample size might be a limitation when analyzing these results, the AUC ROC of troponin I to predict mortality was 0.799 for COVID-19 and 0.615 for CAP, the DeLongs test for compared ROC curves was a p= 0.0351. A. Serum troponin I and mortality due to lower respiratory tract infections B. Serum troponin I to predict mortality in patients with lower tract infections C. ROC curve for serum troponin I to predict risk of mortality Conclusion. Overall, troponin levels were higher among deceased patients. Our findings suggest that high troponin levels are a mortality predictor for patients with COVID-19.

13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S486, 2021.
Article in English | EMBASE | ID: covidwho-1746377

ABSTRACT

Background. Bloodstream infection (BSI) - Central and Non-Central Line Associated - and infections of the lower respiratory tract (RESP) - pneumonia and non pneumonia lower respiratory infections - are some of the main causes of unexpected death in Intensive Care Units (ICUs). Although the leading causes of these infections are already known, risk prediction models can be used to identify unexpected cases. This study aims to investigate whether or not it is possible to build multivariate models to predict BSI and RESP events. Methods. Univariate and multivariate analysis using multiple logistic regression models were built to predict BSI and RESP events. ROC curve analysis was used to validate each model. Independent variables: 29 quantitative parameters and 131 categorical variables. BSI and RESP were identified using Brazilian Health Regulatory Agency protocols with data collected between January and November 2020 from a medical-surgical ICU in a Brazilian Hospital. Definitions: if an infection is 5% or less likely to occur according to the model used and it eventually occurs, it will be classified as "unexpected", or else, if an infection is 10% or less likely to occur, it will be classified as "probably unexpected". Otherwise, infections will be classified as "expected". Patients with a 30% or more risk for BSI or RESP will be classified as "high risk". Results. A total of 1,171 patients were accessed: 70 patients with BSI (95% confidence interval [CI], 3.1%-5%), 66 patients with RESP (95% CI, 2.9%-4.7%), 235 deaths (95% CI, 11.8%-14.9%). Of the 160 potential risk factors evaluated, logistic models for BSI and RESP identified respectively five and seven predictors (Tables 1 and 2, and Figure 1). Patients admitted to the ICU with Covid-19 had a three fold BSI risk and five times more RESP risk than patients without this diagnosis. Conclusion. The built models make possible the identification of the expected infections and the unexpected ones. Three main course of actions can be taken using these models and associated data: (1) Before the occurrence of BSI and RESP: to place high risk patients under more rigorous infection surveillance. (2) After the occurrence of BSI or RESP: to investigate "unexpected" infections. (3) At discharge: to identify high risk patients with no infections for further studies.

14.
Open Forum Infectious Diseases ; 8(SUPPL 1):S687-S688, 2021.
Article in English | EMBASE | ID: covidwho-1746317

ABSTRACT

Background. SARS CoV2 infection produces clinical manifestations of different severity. The pediatric population represents less than 10% of cases, with a mortality of less than 1%. The severity of the condition and mortality are mainly associated with comorbidities. There is controversy about the correlation between the viral load of SARS CoV2 in respiratory samples and the evolution and severity of the clinical picture. The CT (cycle threshold) in the detection of the SARS CoV 2 genome in respiratory samples can be used as an indirect indicator of the viral load in the analyzed samples. Goals. to determine the correlation between the SARS CoV 2 CT values in the detection of the viral genome with the severity of the clinical picture. Describe the clinical, epidemiological, and laboratory characteristics of patients with PCR-confirmed SARS CoV2 infection in respiratory samples. Methods. A retrospective, observational and analytical study that included patients under 15 years of age with confirmed SARS CoV2 infection by PCR of respiratory samples treated at the Hospital Isidoro Iriarte in the city of Quilmes between March 1 2020 and April 30, 2021. Results. 485 patients (n) were included. The distribution by severity of the clinical picture was mild (84%, n = 408), moderate (12%, n = 59) and severe (4%, n = 18). Comorbidities were more frequent among patients with moderate and severe symptoms. Viral load was associated with severity of clinical manifestations. Patients with moderate and severe COVID19 required hospital admission more frequently for a longer time, the use of supplemental oxygen and antibiotics were more frequent in patients with moderate and severe symptoms. Symptoms of lower respiratory tract infection such as cough and respiratory distress were more frequent in patients with moderate and severe symptoms. No patient required admission to the ICU or mechanical ventilation. No patient died. Conclusion. In this study, patients with moderate and severe COVID19 infection had a higher viral load in respiratory samples, a higher frequency of comorbidities, a higher frequency of hospitalization and a longer hospital stay. Lower respiratory symptoms were associated with moderate and severe symptoms, while odynophagia, vomiting, and diarrhea were associated with mild clinical symptoms.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S695, 2021.
Article in English | EMBASE | ID: covidwho-1746311

ABSTRACT

Background. We developed a syndromic algorithm for COVID-19 like illness (CLI) to provide supplementary surveillance data on COVID-19 activity. Methods. The CLI algorithm was developed using the Electronic Medical Record Support for Public Health platform (esphealth.org) and data from five clinical practice groups in Massachusetts that collectively care for 25% of the state's population. Signs and symptoms of CLI were identified using ICD-10 diagnosis codes and measured temperature. The algorithm originally included three categories: Category 1 required codes for coronavirus infection and lower respiratory tract infections (LRTI);Category 2 required an LRTI-related diagnosis and fever;Category 3 required an upper or lower RTI and fever. The three categories mirrored statewide laboratory-confirmed case trends during spring and summer 2020 but did not detect the increase in late fall. We hypothesized this was due to the requirements for fever and LRTI. Therefore, we added three new categories defined by milder symptoms without fever: Category 4 requires LRTIrelated diagnoses only;Category 5 requires upper or lower RTI or olfactory/taste disorders;and Category 6 requires at least one sign of CLI not identified by another category. Results. The six-category algorithm detected the initial surge in April 2020, the summer lull, and the second surge in late fall (see figure). Category 1 cases were not identified until mid-March, which coincides with the first laboratory-confirmed cases in Massachusetts. Categories 2 and 3, which required fever, were prominent during the initial surge but declined over time. Category 5, the broadest category, declined during February and March 2020, likely capturing the end of the influenza season, and successfully detected the spring surge and fall resurgence. Weekly number of COVID-19 like illnesses by category, February 2, 2020 through May 8, 2021 Conclusion. A syndromic definition that included mild upper RTI and olfactory/ taste disorders, with or without fever or LRTI, mirrored changes in laboratory-confirmed COVID-19 cases better than definitions that required fever and LRTI. This suggests a shift in medically attended care and/or coding practices during initial vs subsequent surges of COVID-19, and the importance of using a broad definition of CLI for ongoing surveillance.

16.
Open Forum Infectious Diseases ; 8(SUPPL 1):S760-S761, 2021.
Article in English | EMBASE | ID: covidwho-1746291

ABSTRACT

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019 and has shown worse outcomes in solid organ transplant recipients (SOTR). The clinical differences as well as outcomes between these respiratory viruses have not been well defined in SOTR. Methods. This is a retrospective cohort study of adult SOTR with nasopharyngeal swab or bronchoalveolar lavage PCR positive for either SARS-CoV-2, non-SARSCoV-2 coronavirus, influenza, or respiratory syncytial virus (RSV) from January 2017 to October 2020;both inpatient and outpatient. The follow up period was up to three months. Clinical characteristics and outcomes were evaluated. Development of lower respiratory tract infection (LRTI) was defined as new pulmonary infiltrates with or without symptoms. For statistical analysis, Fischer's exact test and log rank test were performed. Results. During study period, 157 SARS-CoV-2, 72 non-SARS-CoV-2 coronavirus, 100 influenza, 50 RSV infections were identified. Patient characteristics and outcomes are shown in tables 1 and 2, respectively. Secondary infections were not statistically significantly different between SARS-CoV-2 vs. non-SARS-CoV-2 coronavirus and influenza (p=0.25, 0.56) respectively, while it was statistically significant between SARS-CoV-2 and RSV (p=0.0009). Development of LRTI was higher in SARS-CoV-2 when compared to non-SARS-CoV-2 coronavirus (p=0.03), influenza (p=0.0001) and RSV (p=0.003). Admission to ICU was higher with SARS-CoV-2 compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.0001) and RSV (p=0.007). SARS-CoV-2 also had higher rates of mechanical ventilation when compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.01) and RSV (p=0.03). With time to event analysis, higher mortality with SARS-CoV-2 as compared to non-SARSCoV-2 coronavirus, influenza, and RSV (p=0.01) was shown (Figure 1). Conclusion. We found higher incidence of ICU admission, mechanical ventilation, and mortality among SARS-CoV-2 SOTR vs other respiratory viruses. To validate these results, multicenter study is warranted.

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S811-S812, 2021.
Article in English | EMBASE | ID: covidwho-1746271

ABSTRACT

Background. Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in infants. Nirsevimab is a single-dose monoclonal antibody with extended half-life that was shown to protect preterm infants 29 to < 35 weeks gestation against RSV LRTI. However, most medically attended (MA) cases occur in otherwise healthy, term infants for whom there is currently no effective RSV prevention strategy. We report the primary analysis of efficacy and safety, along with the impact of nirsevimab in late preterm and term infants (≥ 35 weeks gestation) in the phase 3 MELODY study (NCT03979313). Methods. Infants were randomized 2:1 to receive one intramuscular injection of nirsevimab (50 mg if < 5 kg;100 mg if ≥ 5 kg at dosing) or placebo entering their first RSV season. The primary endpoint was the incidence of MA RSV LRTI over 150 days postdose. Cases met predefined clinical criteria of disease severity and were confirmed by real-time reverse-transcriptase PCR. Safety was evaluated through 360 days postdose. Enrollment started on 23 July 2019 and was suspended following the declaration of the COVID-19 pandemic by the WHO on 11 March 2020. Results. Overall, 1490 infants were randomized and included in the intent-totreat population;1465 (98%) completed the 150-day efficacy follow-up, and 1367 (92%) completed the 360-day safety follow-up. The incidence of MA RSV LRTI was 1.2% (n=12/994) in the nirsevimab group and 5.0% (n=25/496) in the placebo group, giving nirsevimab an efficacy of 74.5% (95% confidence interval [CI]: 49.6, 87.1;p< 0.0001). Nirsevimab averted 93.6 (95% CI 63.0, 124.0) MA LRTIs per 1000 infants dosed. Nirsevimab was well tolerated, with similar rates of adverse events (87.4% nirsevimab;86.8% placebo) and serious adverse events (6.8% nirsevimab;7.3% placebo) between groups. Conclusion. In this phase 3 study, a single dose of nirsevimab protected late preterm and term infants against MA RSV LRTI over an RSV season with a favorable safety profile. Approximately 11 infants need to be immunized to prevent 1 case of LRTI;nirsevimab has the potential to be an important intervention to reduce the burden of RSV LRTI in healthy infants.

18.
Open Forum Infectious Diseases ; 8(SUPPL 1):S553, 2021.
Article in English | EMBASE | ID: covidwho-1744149

ABSTRACT

Background. Respiratory virus infections are associated with significant and specific local and systemic inflammatory response patterns, which may lead to reactivation of latent viruses. We examined whether viral upper (URTI) or lower respiratory tract infection (LRTI) with common respiratory viruses increased the risk of CMV viremia after allogeneic hematopoietic cell transplantation (HCT). Methods. We retrospectively analyzed patients undergoing allogeneic HCT between 4/2008 and 9/2018. CMV surveillance was performed weekly and the presence of upper and lower respiratory symptoms were evaluated by multiplex respiratory viral PCR. We used Cox proportional hazards models to evaluate risk factors for development of any CMV viremia or high level CMV viremia in the first 100 days post-HCT. Each respiratory virus infection episode was considered positive for 30 days beginning the day of diagnosis. Results. Among 2,545 patients (404 children, 2141 adults), 1,221 and 247 developed CMV viremia and high level CMV viremia, respectively, in the first 100 days post-HCT. Infections due to human rhinoviruses (HRV, N=476) were most frequent, followed by parainfluenza viruses 1-4 (PIV, N=139), seasonal human coronaviruses (COV, N=134), respiratory syncytial virus (RSV, N=77), influenza A/B (FLU, N=35), human metapneumovirus (MPV, N=37), and adenovirus (ADV, N=61). In adjusted models, RSV LRTI was associated with increased risk of developing CMV viremia at all levels (Figures 1 and 2), and PIV or RSV URTI increased the risk of high level CMV viremia;all other viruses showed no association in univariable models. Figure 1. Model estimates for associations between LRTI and development of any CMV viremia Figure 2. Model estimates for associations between LRTI and development of high level CMV viremia Conclusion. We demonstrated that RSV and PIV infections are associated with an increased risk for development of CMV viremia after allogeneic HCT. This novel association provides the rationale to explore virus-specific inflammatory pathways that may trigger CMV reactivation. CMV viremia may also serve as an endpoint in clinical trials that assess new preventative or therapeutic interventions of RSV or PIV infection.

19.
Value in Health ; 25(1):S271, 2022.
Article in English | EMBASE | ID: covidwho-1650308

ABSTRACT

Introduction: More than 300 million people have been vaccinated against Covid-19 in the United States. It is well known that breakthrough infections are common in vaccinated individuals. Depending upon patient age, immunity, comorbidities, drugs, and history of Covid-19, these infections could be mild or severe and, in some cases, may require hospitalization. Objectives: To study the rate of Covid-19 breakthrough infections and associated illness in individuals after receiving mRNA vaccine. Methods: De-identified administrative claims data between December 2020 to March 2021 were used to identify vaccinated individuals (≥18 years). The study considered vaccines that were available in the US at the time of study duration. The first vaccination date was defined as index. Members were followed for two months post index to identify Covid-19 breakthrough infections (as defined by CDC) occurring ≥14 days post index. Patients with continuous enrollment for 90 days post-index were included. Evidence of vaccination was identified using pharmacy claims, while medical claims were used to identify a breakthrough and associated acute respiratory illnesses. Descriptive analysis was conducted to identify patient demographics, geographic location and age and sex wise distribution. Results: A total of 772,222 members had at least one claim for Covid-19 vaccination. Of these, 4631 (males: 1795 and females: 2836) had breakthrough infections with 384 patients reporting associated acute respiratory illness (pneumonia: 213;Acute Respiratory Distress Syndrome: 18;Acute Bronchitis: 10;Upper and Lower Respiratory Tract Infections: 128 and 16, respectively). Conclusions: Unarguably, mass vaccination has helped in reducing the burden of Covid-19 infection. However, viral vaccines are known to provide limited protection and some people may still get infected. Further research is needed to understand nature of emergency visits and conditions that call for ICU or non-ICU hospitalizations

20.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617064

ABSTRACT

Introduction: Respiratory tract diseases are a major cause of morbidity and mortality in children. This study aimed to compare respiratory illness rates and aetiology requiring hospitalization in 2019 (pre-COVID lockdown in Ireland) and 2020 (during COVID lockdown in Ireland). Methodology: Data from medical admissions were retrospectively collected from the emergency department admissions record of a Tertiary Paediatric Hospital in Dublin, Ireland. This study focused on September, October and November in 2019 and 2020. The documented reason for admission in each case was noted;these were transcribed and grouped into categories. Reasons for admission under the category of respiratory included: bronchiolitis, lower respiratory tract infection, upper respiratory tract infection, wheeze, stridor and exacerbation of asthma. Rates of admission in this category were compared from 2019 versus 2020. Rates of investigative nasopharyngeal swabs for these admissions were documented, as well as the resultant viruses isolated. The results were compared across 2019 and 2020. Results: 1040 admission were included in the study. Of these, 620 were in 2019 and 420 in 2020. This alone shows a decrease of 32% in the admissions rate to Temple Street Children's hospital during COVID-19 restrictions. Of the 620 admissions across September, October and November 2019, 265 were attributed to respiratory illnesses (42.77%). In the same time period of 2020, only 67 admissions were attributed to respiratory causes (15.95%). This shows a dramatic decrease in the number of paediatric respiratory illnesses requiring hospital admission. There was a decrease in the number of respiratory panel nasopharyngeal swabs taken in 2020 compared to 2019, although 89% of respiratory admissions were swabbed for Sars-CoV-2 in 2020. Respiratory syncytial virus accounted for 54.60% of respiratory admissions swabbed in 2019 versus a 0% isolation rate in 2020. The table below further outlines virology differences between 2019 and 2020. (table) Conclusion: SARS-CoV-2 pandemic related social restrictions dramatically interfered with the seasonality of childhood respiratory illnesses. This was reflected in the unexpected reduction in the number of hospitalizations in the paediatric population during this period. There is also an obvious stark contrast in the viruses isolated in children presenting with respiratory illnesses in 2019 and 2020. This study raises serious questions and concerns regarding paediatric immunity to respiratory illnesses and begs the question: will we experience a more severe respiratory season in 2021?

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