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3.
JAMA Otolaryngol Head Neck Surg ; 148(11): 1073-1074, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2119055

ABSTRACT

A 6-month-old girl presented to the emergency department for evaluation of fever and was noted to have mild inspiratory stridor, which began acutely at 4 months of age without any inciting illness or event. What is your diagnosis?


Subject(s)
Deglutition Disorders , Respiratory Sounds , Humans , Child , Respiratory Sounds/etiology , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Neck , Diagnosis, Differential
4.
Genome Med ; 14(1): 18, 2022 02 21.
Article in English | MEDLINE | ID: covidwho-1688773

ABSTRACT

BACKGROUND: Measuring host gene expression is a promising diagnostic strategy to discriminate bacterial and viral infections. Multiple signatures of varying size, complexity, and target populations have been described. However, there is little information to indicate how the performance of various published signatures compare to one another. METHODS: This systematic comparison of host gene expression signatures evaluated the performance of 28 signatures, validating them in 4589 subjects from 51 publicly available datasets. Thirteen COVID-specific datasets with 1416 subjects were included in a separate analysis. Individual signature performance was evaluated using the area under the receiving operating characteristic curve (AUC) value. Overall signature performance was evaluated using median AUCs and accuracies. RESULTS: Signature performance varied widely, with median AUCs ranging from 0.55 to 0.96 for bacterial classification and 0.69-0.97 for viral classification. Signature size varied (1-398 genes), with smaller signatures generally performing more poorly (P < 0.04). Viral infection was easier to diagnose than bacterial infection (84% vs. 79% overall accuracy, respectively; P < .001). Host gene expression classifiers performed more poorly in some pediatric populations (3 months-1 year and 2-11 years) compared to the adult population for both bacterial infection (73% and 70% vs. 82%, respectively; P < .001) and viral infection (80% and 79% vs. 88%, respectively; P < .001). We did not observe classification differences based on illness severity as defined by ICU admission for bacterial or viral infections. The median AUC across all signatures for COVID-19 classification was 0.80 compared to 0.83 for viral classification in the same datasets. CONCLUSIONS: In this systematic comparison of 28 host gene expression signatures, we observed differences based on a signature's size and characteristics of the validation population, including age and infection type. However, populations used for signature discovery did not impact performance, underscoring the redundancy among many of these signatures. Furthermore, differential performance in specific populations may only be observable through this type of large-scale validation.


Subject(s)
Bacterial Infections/diagnosis , Datasets as Topic/statistics & numerical data , Host-Pathogen Interactions/genetics , Transcriptome , Virus Diseases/diagnosis , Adult , Bacterial Infections/epidemiology , Bacterial Infections/genetics , Biomarkers/analysis , COVID-19/diagnosis , COVID-19/genetics , Child , Cohort Studies , Diagnosis, Differential , Gene Expression Profiling/statistics & numerical data , Genetic Association Studies/statistics & numerical data , Humans , Publications/statistics & numerical data , SARS-CoV-2/pathogenicity , Validation Studies as Topic , Virus Diseases/epidemiology , Virus Diseases/genetics
6.
CNS Neurosci Ther ; 28(12): 1905-1907, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2037933

ABSTRACT

Neurological features have now been reported very frequently in the ongoing COVID-19 pandemic caused by SARS-CoV-2. The neurological deficits associated features are observed in both acute and chronic stages of COVID-19 and they appear to overlap with wide-ranging symptoms that can be attributed to being of non-neural origins, thus obscuring the definitive diagnosis of neuro-COVID. The pathogenetic factors acting in concert to cause neuronal injury are now emerging, with SARS-CoV-2 directly affecting the brain coupled with the neuroinflammatory factors have been implicated in the causation of disabilities in acute COVID-19 and patients with Long-COVID syndrome. As the differentiation between a neural origin and other organ-based causation of a particular neurological feature is of prognostic significance, it implores a course of action to this covert, yet important neurological challenge.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Pandemics , Diagnosis, Differential
8.
Zhonghua Zhong Liu Za Zhi ; 42(4): 305-311, 2020 Apr 23.
Article in Chinese | MEDLINE | ID: covidwho-2033195

ABSTRACT

Objective: To investigate the principles of differential diagnosis of pulmonary infiltrates in cancer patients during the outbreak of novel coronavirus (2019-nCoV) by analyzing one case of lymphoma who presented pulmonary ground-glass opacities (GGO) after courses of chemotherapy. Methods: Baseline demographics and clinicopathological data of eligible patients were retrieved from medical records. Information of clinical manifestations, history of epidemiology, lab tests and chest CT scan images of visiting patients from February 13 to February 28 were collected. Literatures about pulmonary infiltrates in cancer patients were searched from databases including PUBMED, EMBASE and CNKI. Results: Among the 139 cancer patients who underwent chest CT scans before chemotherapy, pulmonary infiltrates were identified in eight patients (5.8%), five of whom were characterized with GGOs in lungs. 2019-nCoV nuclear acid testing was performed in three patients and the results were negative. One case was a 66-year-old man who was diagnosed with non-Hodgkin lymphoma and underwent CHOP chemotherapy regimen. His chest CT scan image displayed multiple GGOs in lungs and the complete blood count showed decreased lymphocytes. This patient denied any contact with confirmed/suspected cases of 2019-nCoV infection, fever or other respiratory symptoms. Considering the negative result of nuclear acid testing, this patient was presumptively diagnosed with viral pneumonia and an experiential anti-infection treatment had been prescribed for him. Conclusions: The 2019 novel coronavirus disease (COVID-19) complicates the clinical scenario of pulmonary infiltrates in cancer patients. The epidemic history, clinical manifestation, CT scan image and lab test should be taken into combined consideration. The 2019-nCoV nuclear acid testing might be applied in more selected patients. Active anti-infection treatment and surveillance of patient condition should be initiated if infectious disease is considered.


Subject(s)
Antineoplastic Agents/therapeutic use , Coronavirus Infections/diagnostic imaging , Coronavirus , Lung Injury/chemically induced , Lung Injury/diagnostic imaging , Lung/diagnostic imaging , Neoplasms/drug therapy , Pneumonia, Viral/diagnostic imaging , Aged , Antineoplastic Agents/adverse effects , Betacoronavirus , COVID-19 , Coronavirus/pathogenicity , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Diagnosis, Differential , Disease Outbreaks/prevention & control , Humans , Male , Neoplasms/pathology , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Tomography, X-Ray Computed
9.
Dtsch Med Wochenschr ; 147(17): 1096-1103, 2022 09.
Article in German | MEDLINE | ID: covidwho-2016899

ABSTRACT

Dysnatremia is a common occurrence in patients with COVID-19 and is associated with higher mortality and risk for septic conditions. The pathomechanisms are probably multifaceted, but severe hyponatremia may also occur as a result of underlying SIADH or hypocortisolism. Patients with preexisting AVP dysfunction, like SIADH or diabetes insipidus, are at high risk for severe electrolyte imbalances in the event of a COVID-19 infection.The recently growing use of immune checkpoint inhibitors in oncology is associated with a spectrum of endocrine immune-related adverse events (endocrine irAEs). These AEs usually occur unpredictably and may even manifest after discontinuation of the anticancer therapy. Hyponatremia is a common factor of several endocrine irAEs and may serve as a red flag biomarker for possibly underlying endocrine irAEs such as hypophysitis or adrenalitis. New-onset hyponatremia should always prompt a comprehensive diagnostic workup and exclusion of endocrine irAEs before the diagnosis of SIADH is made.Hyponatremia with severe symptoms should be treated with hypertonic (3 %) saline solution to resolve the cerebral edema and prevent from detrimental neurological sequelae. Both rapid intermittent bolus (RIB) therapy and continuous infusion therapy have now been reported to be safe and equally effective. The RIB therapy limits the risk of overcorrection and requires less often re-lowering treatment than continuous infusion therapy.Fluid restriction has long been considered as first-line treatment of chronic hyponatremia due to SIADH. Additional treatment with Furosemid and/or oral NaCl tablets does not improve efficacy but reduces tolerance to therapy.Copeptin-based dynamic tests show higher diagnostic accuracy in the differential diagnosis of patients with hypotonic polyuria polydipsia syndrome than the indirect water deprivation test.


Subject(s)
COVID-19 , Diabetes Insipidus , Diabetes Mellitus , Hyponatremia , Inappropriate ADH Syndrome , COVID-19 Testing , Diagnosis, Differential , Humans , Polydipsia
10.
Perm J ; 26(2): 162-165, 2022 06 29.
Article in English | MEDLINE | ID: covidwho-1988463

ABSTRACT

Introduction With the number of COVID cases in children increasing, the variation in presentation seen in pediatric patients compared with adults has become more apparent. The typical adult presentation of COVID-19 infection, generally associated with acute respiratory symptoms, seems to differ from that seen in children, many of whom are initially asymptomatic. Case Presentation In this case, a previously healthy female adolescent presented with insidious onset nausea and weight loss, but a broad gastrointestinal workup was unrevealing. The delayed development of vertiginous symptoms later led to the identification of prior, asymptomatic COVID-19 infection as the suspected etiology of her presenting gastrointestinal symptoms. Conclusion This case highlights the notion that COVID-19 infection in children may have a delayed manifestation in the absence of acute respiratory systems. Given this, COVID should be included in the differential diagnosis early on in an effort to limit the risks and costs associated with broad, unrevealing workups.


Subject(s)
COVID-19 , Vestibular Neuronitis , Adolescent , Adult , COVID-19/complications , Child , Diagnosis, Differential , Female , Humans , Vertigo/diagnosis , Vestibular Neuronitis/complications , Vestibular Neuronitis/diagnosis
11.
Orv Hetil ; 163(27): 1061-1065, 2022 Jul 03.
Article in English | MEDLINE | ID: covidwho-1978878

ABSTRACT

The Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) is an autolimited process, which can be caused by viral agents like Epstein-Barr virus, human herpes virus, HIV, B19 parvovirus, paromyxoviruses, SARS-CoV-2, Toxoplasma and Yersinia. The correct diagnosis is based on histological findings. A 45-year-old female patient presented in our ambulatory room with a unilateral neck mass, fever, dysphonia and dysphagia. The patient was double-tested positive for SARS-CoV-2 approximately 1 month before the symptoms started. Before examination, the nasopharyngeal rapid test for SARS-CoV-2 resulted negative. After hospitalization, intravenous antibiotic (Augmentin, 3 × 1.2 g; Klion, 2 × 100 mg) and steroid (Solu-Medrol, 2 × 125 mg) therapy were administered. The neck and chest CT described a right-sided retropharyngeal abscess with bilateral neck lympadenopathy. Urgent tracheotomy, neck dissection and lymph node biopsy were made. The intraoperative findings excluded the presence of the abscess. The histological findings confirmed the necrotizing histiocytic lymphadenitis. Despite of the fact that the Kikuchi-Fujimoto disease is autolimited, we can see that, in this particular case, the lymphadenopathy after the SARS-CoV-2 infection caused a life-threatening situation. The formed extratissular liquid imitated the image of a retropharyngeal abscess. In the searched worldwide literature, similar intervention for this type of process was not described. Tracheotomy, neck dissection and removing the lymph nodes as ,,trigger zones" caused the full recovery of the patient. In the future, we consider important proving and clarifying the correlation between SARS-CoV-2 and Kikuchi-Fujimoto disease. Orv Hetil. 2022; 163(27): 1061-1065.


Subject(s)
COVID-19 , Epstein-Barr Virus Infections , Histiocytic Necrotizing Lymphadenitis , Retropharyngeal Abscess , COVID-19/complications , COVID-19/diagnosis , Diagnosis, Differential , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/pathology , Female , Herpesvirus 4, Human , Histiocytic Necrotizing Lymphadenitis/complications , Histiocytic Necrotizing Lymphadenitis/diagnosis , Histiocytic Necrotizing Lymphadenitis/drug therapy , Humans , Lymph Nodes , Middle Aged , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/pathology , SARS-CoV-2
12.
Chest ; 162(2): e85-e88, 2022 08.
Article in English | MEDLINE | ID: covidwho-1972016

ABSTRACT

CASE PRESENTATION: A 54-year-old man with chronic hepatitis B was admitted to the hospital with progressive dyspnea on exertion. He reported experiencing intermittent fever, dyspnea on exertion, and relapsing pleuritic chest pain starting 6 months prior, after his first dose of the ChAdOx1 nCoV-19 vaccine. In the past 2 months, he had been admitted to the hospital twice and diagnosed with recurrent pneumonia. Under antibiotic treatment, his dyspnea and low-grade fever demonstrated waxing and waning behaviors. Migratory pulmonary consolidation, which moved from the left lower lobe to the right middle lobe, was identified and diagnosed as relapsing pneumonia. Chest CT scan was performed in a previous admission 2 months earlier that revealed multifocal peripheral consolidation in the left lower lobe and right middle lobe. His occupation required the maintenance of overall fitness, and he denied immunosuppressant use, illicit drug abuse, cigarette smoking, suspicious travel, suspicious contact, or family history. No recent history of trauma, surgery, or air travel was reported.


Subject(s)
ChAdOx1 nCoV-19 , Lung Diseases , Chest Pain/diagnosis , Diagnosis, Differential , Dyspnea/diagnosis , Dyspnea/etiology , Fever/diagnosis , Humans , Lung Diseases/diagnosis , Male , Middle Aged , Tomography, X-Ray Computed
13.
Rev Mal Respir ; 39(7): 626-632, 2022 Sep.
Article in French | MEDLINE | ID: covidwho-1967088

ABSTRACT

INTRODUCTION: Immune checkpoint inhibitors have revolutionized the management of many cancers and achieved efficacy and durable response for some patients, including those with advanced cancers. However, immunotherapy is associated with side effects caused by the infiltration of immune cells into normal tissues, which can lead to disproportionate dysimmune reactions. While mostly of moderate intensity, these side effects can affect any organ, including the lung, the site of occasionally life-threatening interstitial lung disease. Their presentation can be similar to that of infectious pneumonia (COVID-19). OBSERVATIONS: We report the cases of 3 patients who presented between March and May 2020 with severe pulmonary toxicities secondary to immunotherapy, which led to with an initial hypothesis of SARS-CoV-2 pneumonia. After extensive investigations, the diagnosis of pulmonary toxicity to immunotherapy was given, and the clinical and radiological course following the initiation of corticosteroid therapy was favorable. CONCLUSION: Pulmonary toxicity secondary to immunotherapy remains a rare but potentially life-threatening side effect. The diagnostic approach requires the elimination of several differential diagnoses (infectious process, tumor progression, other etiologies of interstitial lung disease). This adverse event is reversible and evolution after initiation of corticosteroid therapy is usually favorable.


Subject(s)
COVID-19 , Neoplasms , Pneumonia , Adrenal Cortex Hormones/therapeutic use , COVID-19/diagnosis , COVID-19 Testing , Diagnosis, Differential , Humans , Neoplasms/therapy , Pneumonia/diagnosis , SARS-CoV-2
14.
ARP Rheumatol ; 1(3): 257-259, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-1957887

ABSTRACT

A 41-year-old woman with pre-radiographic axial and peripheric spondyloarthritis, taking adalimumab since 2010, started motor impairment of the right limbs and numbness of the left leg seven days after the administration of COVID-19 mRNA vaccine. Adalimumab was taken 47 days before clinical onset. A comprehensive study for infectious, autoimmune and neoplastic causes were unremarkable. MRI depicted an acute inflammatory lesion at C2 level with gadolinium enhancement. The patient started methylprednisolone with clinical improvement. Three scenarios should be considered: primary CNS inflammatory disorder or a secondary manifestation of the underlying rheumatologic disease; immune-mediated inflammatory lesion triggered by vaccine; demyelinating event due to adalimumab.


Subject(s)
Brown-Sequard Syndrome , COVID-19 Vaccines , COVID-19 , Spondylarthritis , Adult , Female , Humans , Adalimumab/adverse effects , Brown-Sequard Syndrome/diagnosis , Contrast Media , COVID-19 Vaccines/adverse effects , Diagnosis, Differential , Gadolinium , Spondylarthritis/complications
16.
BMJ Case Rep ; 15(6)2022 Jun 20.
Article in English | MEDLINE | ID: covidwho-1901949

ABSTRACT

Vitamin C deficiency, historically known as scurvy, was associated with sailors in the Victorian times, however, a global review in 2020 suggests it still exists in certain at-risk groups.A case is presented of a young non-verbal child with learning difficulties and on a restricted diet, in which the primary symptom was gingival inflammation. It posed a diagnostic dilemma due to the non-specific symptoms, and a delay in the diagnosis, until vitamin C deficiency was confirmed.Gingival inflammation is one of the common findings in vitamin C deficiency and dental professionals may be the first point of contact. The importance of dietary evaluation, identifying and looking for other signs and liaising with the medical colleagues are discussed.This case highlights the role of the dentist in identifying latent cases of vitamin C deficiency and to consider this as a differential diagnosis especially in certain at-risk groups.


Subject(s)
Ascorbic Acid Deficiency , Scurvy , Ascorbic Acid/therapeutic use , Ascorbic Acid Deficiency/complications , Ascorbic Acid Deficiency/diagnosis , Child , Diagnosis, Differential , Humans , Inflammation/diagnosis , Scurvy/complications , Scurvy/diagnosis
17.
Rural Remote Health ; 21(2): 6166, 2021 06.
Article in English | MEDLINE | ID: covidwho-1893575

ABSTRACT

In 2020, a girl aged 5 years presented to the coronavirus assessment centre on a remote Scottish island with symptoms consistent with novel coronavirus 2019 (COVID-19). Her mother was concerned as she had noted the patient to have an irregular pulse. COVID-19 has been shown to cause cardiac arrhythmia, and so after discussion with tertiary paediatric cardiology services an ECG was recommended. In order to minimise potential spread of coronavirus in the healthcare setting a portable ECG device was immediately delivered to the patient, with the ECG tracing being sent electronically to a cardiologist. A formal diagnosis was then communicated to the parents within 2 hours of the initial contact.


Subject(s)
Arrhythmias, Cardiac/etiology , Electrocardiography/methods , Respiratory Tract Infections/diagnosis , Rural Population , Telemedicine/methods , COVID-19/diagnosis , COVID-19/prevention & control , Child, Preschool , Cough/etiology , Diagnosis, Differential , Female , Fever/etiology , Humans , SARS-CoV-2
18.
Lett Appl Microbiol ; 74(6): 1001-1007, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1891648

ABSTRACT

African swine fever (ASF), a highly contagious and lethal disease, poses a tremendous threat and burden to the swine industry worldwide. Lack of available vaccines or treatments leaves rapid diagnosis as the key tool to control the disease. Quantum dots (QDs) are unique fluorescent semiconductor nanoparticles, highly versatile for biological applications. In this study, we developed a quantum dots-based fluorescent immunochromatographic assay (QDs-FICA) using CD2v as the diagnosis antigen to detect ASFV antibodies. The titre of the test strip was 1 : 5·12 × 105 . In addition, the strip was highly specific to anti-ASFV serum and had no cross-reaction with CSFV, PPV, PRRSV, PCV-2, PRV and FMDV. Moreover, a comparative test of 71 clinical samples showed that the coincidence rate was 85·92% between the test strip and the commercial ELISA kit (coated with p30, p62 and p72). The QDs-FICA can be used to detect ASFV antibodies, which is meaningful for the surveillance, control and purification of ASF.


Subject(s)
African Swine Fever Virus , African Swine Fever , Quantum Dots , African Swine Fever/diagnosis , African Swine Fever/prevention & control , Animals , Diagnosis, Differential , Immunoassay , Swine
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