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1.
Chest ; 159(3): e159-e162, 2021 03.
Article in English | MEDLINE | ID: covidwho-1108124

ABSTRACT

CASE PRESENTATION: A 78-year-old woman was admitted to the ED with a 10-day history of diarrhea and recent onset of dry cough, fever, and asthenia. She had a medical history of obesity (BMI 32) and arterial hypertension treated with irbesartan. In the context of a large-scale lockdown in France during the COVID-19 pandemic, she only had physical contact with her husband, who did not report any symptoms. She required mechanical ventilation because of severe hypoxemia within 1 hour after admission to the ED.


Subject(s)
/methods , Lung/diagnostic imaging , Respiration, Artificial/methods , Respiratory Insufficiency , Tomography, X-Ray Computed/methods , Aged , /epidemiology , /therapy , Comorbidity , Diagnosis, Differential , Diarrhea/diagnosis , Diarrhea/etiology , Female , Humans , Obesity/diagnosis , Obesity/epidemiology , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Treatment Outcome
2.
Cochrane Database Syst Rev ; 2: CD013665, 2021 02 23.
Article in English | MEDLINE | ID: covidwho-1095222

ABSTRACT

BACKGROUND: The clinical implications of SARS-CoV-2 infection are highly variable. Some people with SARS-CoV-2 infection remain asymptomatic, whilst the infection can cause mild to moderate COVID-19 and COVID-19 pneumonia in others. This can lead to some people requiring intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever, cough, or loss of smell or taste, and signs such as oxygen saturation are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19, or select patients for further testing. This is an update of this review, the first version of which published in July 2020. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19. SEARCH METHODS: For this review iteration we undertook electronic searches up to 15 July 2020 in the Cochrane COVID-19 Study Register and the University of Bern living search database. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with clinically suspected COVID-19, or if they recruited known cases with COVID-19 and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies in hospitalised patients were only included if symptoms and signs were recorded on admission or at presentation. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. We presented sensitivity and specificity in paired forest plots, in receiver operating characteristic space and in dumbbell plots. We estimated summary parameters using a bivariate random-effects meta-analysis whenever five or more primary studies were available, and whenever heterogeneity across studies was deemed acceptable. MAIN RESULTS: We identified 44 studies including 26,884 participants in total. Prevalence of COVID-19 varied from 3% to 71% with a median of 21%. There were three studies from primary care settings (1824 participants), nine studies from outpatient testing centres (10,717 participants), 12 studies performed in hospital outpatient wards (5061 participants), seven studies in hospitalised patients (1048 participants), 10 studies in the emergency department (3173 participants), and three studies in which the setting was not specified (5061 participants). The studies did not clearly distinguish mild from severe COVID-19, so we present the results for all disease severities together. Fifteen studies had a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. This may have especially influenced the sensitivity of those features used in referral protocols, such as fever and cough. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional 12 studies, we were unable to assess the risk for selection bias. This makes it very difficult to judge the validity of the diagnostic accuracy of the signs and symptoms from these included studies. The applicability of the results of this review update improved in comparison with the original review. A greater proportion of studies included participants who presented to outpatient settings, which is where the majority of clinical assessments for COVID-19 take place. However, still none of the studies presented any data on children separately, and only one focused specifically on older adults. We found data on 84 signs and symptoms. Results were highly variable across studies. Most had very low sensitivity and high specificity. Only cough (25 studies) and fever (7 studies) had a pooled sensitivity of at least 50% but specificities were moderate to low. Cough had a sensitivity of 67.4% (95% confidence interval (CI) 59.8% to 74.1%) and specificity of 35.0% (95% CI 28.7% to 41.9%). Fever had a sensitivity of 53.8% (95% CI 35.0% to 71.7%) and a specificity of 67.4% (95% CI 53.3% to 78.9%). The pooled positive likelihood ratio of cough was only 1.04 (95% CI 0.97 to 1.11) and that of fever 1.65 (95% CI 1.41 to 1.93). Anosmia alone (11 studies), ageusia alone (6 studies), and anosmia or ageusia (6 studies) had sensitivities below 50% but specificities over 90%. Anosmia had a pooled sensitivity of 28.0% (95% CI 17.7% to 41.3%) and a specificity of 93.4% (95% CI 88.3% to 96.4%). Ageusia had a pooled sensitivity of 24.8% (95% CI 12.4% to 43.5%) and a specificity of 91.4% (95% CI 81.3% to 96.3%). Anosmia or ageusia had a pooled sensitivity of 41.0% (95% CI 27.0% to 56.6%) and a specificity of 90.5% (95% CI 81.2% to 95.4%). The pooled positive likelihood ratios of anosmia alone and anosmia or ageusia were 4.25 (95% CI 3.17 to 5.71) and 4.31 (95% CI 3.00 to 6.18) respectively, which is just below our arbitrary definition of a 'red flag', that is, a positive likelihood ratio of at least 5. The pooled positive likelihood ratio of ageusia alone was only 2.88 (95% CI 2.02 to 4.09). Only two studies assessed combinations of different signs and symptoms, mostly combining fever and cough with other symptoms. These combinations had a specificity above 80%, but at the cost of very low sensitivity (< 30%). AUTHORS' CONCLUSIONS: The majority of individual signs and symptoms included in this review appear to have very poor diagnostic accuracy, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out COVID-19. The presence of anosmia or ageusia may be useful as a red flag for COVID-19. The presence of fever or cough, given their high sensitivities, may also be useful to identify people for further testing. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19, are still urgently needed. Results from such studies could inform subsequent management decisions.


Subject(s)
Ambulatory Care , Primary Health Care , Symptom Assessment , Ageusia/diagnosis , Ageusia/etiology , /etiology , Arthralgia/diagnosis , Arthralgia/etiology , Bias , /epidemiology , Cough/diagnosis , Cough/etiology , Diarrhea/diagnosis , Diarrhea/etiology , Dyspnea/diagnosis , Dyspnea/etiology , Fatigue/diagnosis , Fatigue/etiology , Fever/diagnosis , Fever/etiology , Headache/diagnosis , Headache/etiology , Humans , Myalgia/diagnosis , Myalgia/etiology , Outpatient Clinics, Hospital/statistics & numerical data , Pandemics , Physical Examination , Selection Bias , Symptom Assessment/classification , Symptom Assessment/statistics & numerical data
3.
Neurogastroenterol Motil ; 33(3): e14104, 2021 03.
Article in English | MEDLINE | ID: covidwho-1085279

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, infects gastrointestinal epithelial cells expressing angiotensin-converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS-CoV-2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID-19. Liver and pancreas dysfunctions have also been described as non-respiratory complications of COVID-19 and add further emphasis to the common view of SARS-CoV-2 infection as a systemic disease with multiorgan involvement. PURPOSE: The aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS-CoV-2 infection, including the crosstalk with the gut microbiota, the fecal-oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID-19.


Subject(s)
/complications , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/physiopathology , Gastrointestinal Microbiome/physiology , Gastrointestinal Tract/physiopathology , Animals , Diarrhea/etiology , Diarrhea/physiopathology , Diarrhea/virology , Dysbiosis/etiology , Dysbiosis/physiopathology , Dysbiosis/virology , Enteric Nervous System/physiopathology , Enteric Nervous System/virology , Gastrointestinal Diseases/virology , Gastrointestinal Tract/virology , Humans , Liver Diseases/etiology , Liver Diseases/physiopathology , Liver Diseases/virology , Pancreatic Diseases/etiology , Pancreatic Diseases/physiopathology , Pancreatic Diseases/virology
4.
Twin Res Hum Genet ; 23(6): 316-321, 2020 12.
Article in English | MEDLINE | ID: covidwho-1072088

ABSTRACT

Susceptibility to infection such as SARS-CoV-2 may be influenced by host genotype. TwinsUK volunteers (n = 3261) completing the C-19 COVID-19 symptom tracker app allowed classical twin studies of COVID-19 symptoms, including predicted COVID-19, a symptom-based algorithm to predict true infection, derived from app users tested for SARS-CoV-2. We found heritability of 49% (32-64%) for delirium; 34% (20-47%) for diarrhea; 31% (8-52%) for fatigue; 19% (0-38%) for anosmia; 46% (31-60%) for skipped meals and 31% (11-48%) for predicted COVID-19. Heritability estimates were not affected by cohabiting or by social deprivation. The results suggest the importance of host genetics in the risk of clinical manifestations of COVID-19 and provide grounds for planning genome-wide association studies to establish specific genes involved in viral infectivity and the host immune response.


Subject(s)
/etiology , /epidemiology , Diarrhea/etiology , Diarrhea/genetics , Diarrhea/virology , Diseases in Twins , Fatigue/etiology , Fatigue/genetics , Fatigue/virology , Humans , Mobile Applications , Prevalence , Self Report , Twins, Dizygotic , Twins, Monozygotic
5.
Epidemiol Prev ; 44(5-6 Suppl 2): 216-225, 2020.
Article in English | MEDLINE | ID: covidwho-1068142

ABSTRACT

OBJECTIVES: to explore clinical and epidemiological characteristics associated with an imaging feature of COVID-19 pneumonia at disease onset, in order to identify factors that may be evaluable by general practitioners at patient's home, and which may lead to identify a more severe disease, needing hospitalization. DESIGN: this is a retrospective/prospective observational hospital cohort. SETTING AND PARTICIPANTS: the study population includes all patients consecutively admitted to the emergency department of Città della salute e della scienza University Hospital from 01.03 to 31.05.2020 with a confirmed diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES: patients were classified in two groups according to the findings of X-ray imaging, lung ultrasound and chest computer tomography, as pneumonia or not pneumonia patients. RESULTS: in multivariable analysis, factors most strongly associated with emergency department admission with pneumonia were age, oxygen saturation <90% (adj OR 4.16 ;95%CI 1.44-12.07), respiratory rate >24 breaths/min (adj OR 6.50; 95%CI 2.36-17.87), fever ≥38° (adj OR 3.05; 95%CI 1.53-6.08) and the presence of gastroenteric symptoms (vomiting and diarrhea). A delay (> 7 days) between the appearance of the initial lung symptoms (cough and dyspnea) and the admission to the emergency department was also related to a higher probability of receiving a positive imaging report (OR 4.99; 95%CI 2,02-12,34). CONCLUSIONS: in order to reorganize the management of COVID-19 patients in Italy, in view of the risk of a second wave of epidemic or of local outbreaks, it would be desirable to relocate the triage, and possibly the patient's care, from hospital to home. In this scenario it is important to identify all symptoms and signs associated with COVID-19 pneumonia that would facilitate the decision-making process of GPs leading to patients hospitalization.


Subject(s)
/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , Comorbidity , Diarrhea/epidemiology , Diarrhea/etiology , Dyspnea/epidemiology , Dyspnea/etiology , Emergency Service, Hospital/statistics & numerical data , Female , Hospitals, University/statistics & numerical data , Humans , Italy/epidemiology , Leukocyte Count , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Oxygen/blood , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/virology , Prospective Studies , Respiratory Rate , Retrospective Studies , Symptom Assessment , Time Factors , Vomiting/epidemiology , Vomiting/etiology
6.
BMC Infect Dis ; 21(1): 141, 2021 Feb 03.
Article in English | MEDLINE | ID: covidwho-1063188

ABSTRACT

BACKGROUND: The impact of COVID-19 has been devastating on a global scale. The negative conversion time (NCT) of SARS-CoV-2 RNA is closely related to clinical manifestation and disease progression in COVID-19 patients. Our study aimed to predict factors associated with prolonged NCT of SARS-CoV-2 RNA in mild/moderate COVID-19 patients. METHODS: The clinical features, laboratory data and treatment outcomes of COVID-19 patients were retrospectively analyzed. Then univariate and multivariate analysis were used to screen out risk factors of influencing prolonged NCT of SARS-CoV-2 RNA. RESULTS: Thirty-two hospitalized mild/moderate COVID-19 patients were enrolled. The general clinical symptoms were cough (78.1%), fever (75%), diarrhea (68.8%), expectoration (56.3%), and nausea (37.5%). More than 40% of the patients had decreased erythrocyte, hemoglobin and leucocyte and 93.8% patients were detected in abnormalities of chest CT. The median NCT of SARS-CoV-2 RNA was 19.5 days (IQR: 14.25-25). Univariate analysis found fever, nausea, diarrhea and abnormalities in chest CTs were positively associated with prolonged NCT of viral RNA (P< 0.05). The multivariate Cox proportional hazard model revealed that fever [Exp (B), 0.284; 95% CI, 0.114-0.707; P<0.05] and nausea [Exp (B), 0.257; 95%CI, 0.096-0.689; P<0.05] were two significant independent factors. CONCLUSIONS: Fever and nausea were two significant independent factors in prolonged NCT of viral RNA in mild/moderate COVID-19 patients, which provided a useful references for disease progression and treatment of COVID-19.


Subject(s)
/diagnosis , RNA, Viral/metabolism , /genetics , Adult , /pathology , Cough/etiology , Diarrhea/etiology , Female , Fever/etiology , Hospitalization , Humans , Male , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Severity of Illness Index , Thorax/diagnostic imaging , Time Factors
7.
Cir Pediatr ; 34(1): 3-8, 2021 Jan 01.
Article in English, Spanish | MEDLINE | ID: covidwho-1052678

ABSTRACT

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.


Subject(s)
Abdomen, Acute/diagnosis , Abdominal Pain/etiology , /diagnosis , Abdomen, Acute/surgery , Abdomen, Acute/virology , Abdominal Pain/virology , Adolescent , Appendicitis/diagnosis , Child , Child, Preschool , Diarrhea/epidemiology , Diarrhea/etiology , Female , Fever/epidemiology , Fever/etiology , Humans , Intensive Care Units/statistics & numerical data , Male , Peritonitis/diagnosis , Retrospective Studies , Vomiting/epidemiology , Vomiting/etiology
8.
Acta Med Indones ; 52(3): 283-289, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-833686

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a new infectious disease that spreads very rapidly and therefore, WHO has declared it as a global pandemic disease. The main clinical symptoms found in COVID-19 patients are cough and fever; however, in some cases, diarrhea can be one of the early symptoms. The present case report describes a patient who came with a complaint of diarrhea without fever and she was later confirmed to be positive for COVID-19 during hospitalization. The presence of unspecified initial symptoms calls for greater vigilance from health workers in establishing diagnosis patients with COVID-19.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/complications , Diarrhea/etiology , Pandemics , Pneumonia, Viral/complications , RNA, Viral/analysis , Aged , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Diarrhea/diagnosis , Female , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Time Factors
9.
Dig Liver Dis ; 52(10): 1076-1079, 2020 10.
Article in English | MEDLINE | ID: covidwho-803444

ABSTRACT

Objective: To explore the clinical characteristics of Coronavirus Disease (COVID-19) patients with gastrointestinal symptoms. Methods: The clinical data of 164 COVID-19 patients with gastrointestinal symptoms were extracted and analysed retrospectively. Results: In total, 505 COVID-19 patients were divided into two groups: those with gastrointestinal symptoms (G group) and those without gastrointestinal symptoms (NG group). Common gastrointestinal symptoms included inappetence, diarrhoea, nausea, abdominal pain, and vomiting. Significantly higher proportions of patients with fever, dizziness, myalgia, and fatigue were noted in group G than in group NG. Compared with patients without fever, there was a significant difference between G group and NG group in moderate fever or above, while there was no significant difference between the two groups in low fever. The laboratory results showed that patients in the G group had significantly higher C-reactive protein, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase levels than those in the NG group. Moreover, the proportion of patients with severe pneumonia was significantly higher in the G group than in the NG group. Conclusion: In Wuhan, the proportion of COVID-19 patients who experience gastrointestinal symptoms is relatively high. Patients who experience gastrointestinal symptoms are more likely to suffer from severe pneumonia, which may help clinicians identify patients at high risk of COVID-19 and thus reduce the incidence of this condition.


Subject(s)
Abdominal Pain/physiopathology , Anorexia/physiopathology , Coronavirus Infections/physiopathology , Diarrhea/physiopathology , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Vomiting/physiopathology , Abdominal Pain/etiology , Abdominal Pain/metabolism , Adult , Aged , Anorexia/etiology , Anorexia/metabolism , Betacoronavirus , C-Reactive Protein/metabolism , Case-Control Studies , Coronavirus Infections/complications , Coronavirus Infections/metabolism , Diarrhea/etiology , Diarrhea/metabolism , Dizziness/etiology , Dizziness/physiopathology , Fatigue/etiology , Fatigue/physiopathology , Female , Fever/etiology , Fever/physiopathology , Humans , Hydroxybutyrate Dehydrogenase/metabolism , L-Lactate Dehydrogenase/metabolism , Male , Middle Aged , Myalgia/etiology , Myalgia/physiopathology , Nausea/etiology , Nausea/metabolism , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/metabolism , Retrospective Studies , Severity of Illness Index , Vomiting/etiology , Vomiting/metabolism
10.
Bull Cancer ; 107(10): 1019-1023, 2020 Oct.
Article in French | MEDLINE | ID: covidwho-797097

ABSTRACT

In this review, we report a case of a bone's metastatic breast cancer in Malian patient treated by chemotherapy in whom SRAS-COV-2's diagnosis was made 9days after the onset gastrointestinal symptoms. Patient quickly died before any COVID-19's treatment. According to the poor outcomes of cancer patients with COVID-19, authors emphasize to an intensive attention to such patients in order to find the best therapeutic balance between the two pathologies during this pandemic.


Subject(s)
Betacoronavirus , Breast Neoplasms/complications , Carcinoma, Ductal, Breast/secondary , Coronavirus Infections/complications , Diarrhea/etiology , Pandemics , Pneumonia, Viral/complications , Spinal Neoplasms/secondary , Vomiting/etiology , Adult , Antineoplastic Agents, Phytogenic/therapeutic use , Bone Density Conservation Agents/therapeutic use , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/drug therapy , Docetaxel/therapeutic use , Fatal Outcome , Female , HIV Infections/complications , Humans , Liver Neoplasms/complications , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Spinal Neoplasms/complications , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/drug therapy , Tomography, X-Ray Computed , Zoledronic Acid/therapeutic use
11.
Mil Med Res ; 7(1): 45, 2020 09 23.
Article in English | MEDLINE | ID: covidwho-781559

ABSTRACT

BACKGROUND: Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. CASE PRESENTATION: We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. CONCLUSION: When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Diarrhea/therapy , Gastrointestinal Hemorrhage/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Aged , Coronavirus Infections/diagnosis , Diarrhea/etiology , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Humans , Immunization, Passive/methods , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Recurrence , Sampling Studies , Severity of Illness Index , Taiwan , Treatment Outcome
12.
Clinics (Sao Paulo) ; 75: e2209, 2020.
Article in English | MEDLINE | ID: covidwho-749235

ABSTRACT

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/virology , Abdominal Pain/etiology , Betacoronavirus , Child , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Cross-Sectional Studies , Diarrhea/etiology , Fever/etiology , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/virology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Respiration, Artificial , Severity of Illness Index , Systemic Inflammatory Response Syndrome/therapy , Vomiting/etiology
13.
Rev Soc Bras Med Trop ; 53: e20200494, 2020.
Article in English | MEDLINE | ID: covidwho-740419

ABSTRACT

Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , Diarrhea/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , Abdominal Pain/etiology , Betacoronavirus , Child, Preschool , Clinical Laboratory Techniques , Cluster Analysis , Contact Tracing , Diarrhea/etiology , Fever/etiology , Humans , Male , Pharyngitis/etiology
14.
Gastroenterol Hepatol ; 43(8): 464-471, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-733849

ABSTRACT

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Digestive System Diseases/etiology , Digestive System/virology , Pandemics , Pneumonia, Viral/complications , Aerosols , Anorexia/etiology , Antiviral Agents/adverse effects , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , Cohort Studies , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Diarrhea/etiology , Digestive System Diseases/virology , Endoscopy, Digestive System/adverse effects , Feces/virology , Humans , Immunosuppressive Agents/adverse effects , Intestines/chemistry , Intestines/virology , Liver Diseases/etiology , Multicenter Studies as Topic , Pandemics/prevention & control , Peptidyl-Dipeptidase A/analysis , Peptidyl-Dipeptidase A/physiology , Personal Protective Equipment , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Receptors, Virus/analysis , Receptors, Virus/physiology , Risk , Universal Precautions
15.
Virus Res ; 289: 198147, 2020 11.
Article in English | MEDLINE | ID: covidwho-733589

ABSTRACT

BACKGROUND: To investigate the clinical significance, viral shedding duration and viral load dynamics of positive fecal SARS-CoV-2 signals in COVID-19. METHODS: COVID-19 patients were included. SARS-CoV-2 RNA was tested in stool and respiratory specimens until two sequential negative results were obtained. Clinical, laboratory and imaging data were recorded. RESULTS: Of the 69 COVID-19 patients, 20 (28.99 %) had positive fecal viral tests who were younger, had lower C-reactive protein (CRP) and fibrinogen (FIB) levels on admission (all P < 0.05), and showed more improvement and less progression on chest CT during recovery. The median duration of positive viral signals was significantly longer in stool samples than in respiratory samples (P < 0.05). In spite of the negative oropharyngeal swabs, eleven patients were tested positive for viral RNA in stool specimens, with their fecal SARS-CoV-2 RNA Ct (cycle threshold) values reaching 25-27. 6 of these 11 patients' Ct values rebounded. CONCLUSION: SARS-CoV-2 RNA in stool specimens was associated with a milder condition and better recovery of chest CT results while the median duration of SARS-CoV-2 RNA persistence was significantly longer in fecal samples than in oropharyngeal swabs. The fecal viral load easily reached a high level and rebounded even though respiratory signals became negative.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/virology , Feces/virology , Pneumonia, Viral/virology , RNA, Viral/analysis , Virus Shedding , Adult , C-Reactive Protein/analysis , Coronavirus Infections/blood , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/transmission , Diarrhea/etiology , Diarrhea/virology , False Negative Reactions , Female , Fibrinogen/analysis , Humans , Lung/diagnostic imaging , Male , Middle Aged , Oropharynx/virology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/transmission , Prognosis , RNA Stability , Real-Time Polymerase Chain Reaction , Symptom Assessment , Viral Load
17.
Aging (Albany NY) ; 12(15): 15730-15740, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-721664

ABSTRACT

BACKGROUND: SARS-CoV-2 has raged around the world since March, 2020. We aim to describe the clinical characteristics and risk factors of severe patients with COVID-19 in Guangzhou. RESULTS: The severity and mortality of COVID-19 was 10.4% and 0.3% respectively. And each 1-year increase in age (OR, 1.057; 95% CI, 1.018-1.098; P=0.004), Wuhan exposure history greater than 2 weeks (OR, 2.765; 95% CI, 1.040-7.355; P=0.042), diarrhea (OR, 24.349; 95% CI, 3.580-165.609; P=0.001), chronic kidney disease (OR, 6.966; 95% CI, 1.310-37.058; P = 0.023), myoglobin higher than 106 µg/L (OR, 8.910; 95% CI, 1.225-64.816; P=0.031), white blood cell higher than 10×109/L (OR, 5.776; 95% CI, 1.052-31.722; P=0.044), and C-reactive protein higher than 10 mg/L (OR, 5.362; 95% CI, 1.631-17.626; P=0.006) were risk factors for severe cases. CONCLUSION: Older age, Wuhan exposure history, diarrhea, chronic kidney disease, elevated myoglobin, elevated white blood cell and C-reactive protein were independent risk factors for severe patients with COVID-19 in Guangzhou. METHODS: We included 288 adult patients with COVID-19 and compared the data between severe and non-severe group. We used univariate and multivariate logistic regression methods to explore risk factors of severe cases.


Subject(s)
C-Reactive Protein/analysis , Coronavirus Infections , Diarrhea , Leukocyte Count/methods , Myoglobin/analysis , Pandemics , Pneumonia, Viral , Renal Insufficiency, Chronic/epidemiology , Age Factors , Betacoronavirus/isolation & purification , China/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Diarrhea/diagnosis , Diarrhea/etiology , Female , Humans , Infectious Disease Incubation Period , Male , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/etiology , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Risk Factors , Severity of Illness Index
18.
J Investig Med High Impact Case Rep ; 8: 2324709620949307, 2020.
Article in English | MEDLINE | ID: covidwho-708945

ABSTRACT

The novel coronavirus disease has brought the world to standstill with high infectivity and rapid transmission. The disease caused by novel coronavirus is termed as coronavirus disease 2019 (COVID-19). We present the case of a renal transplant patient who was infected with COVID-19 through community spread and presented with fever and gastrointestinal symptoms. Transplant recipients are particularly vulnerable because of the immunosuppressed state. These patients can shed a virus for a prolonged period and can have a higher load of the virus. There have been no COVID-19 cases transmitted through organ donation. Preinfection immunological impairment can aggravate the severity of the infection. The transplant team plays a crucial role in donor and recipient evaluation and guiding the timing of the transplant. Although specific published data are lacking with regard to transplant recipients, they should follow the same precautions as the general population, like avoiding nonessential travel and practice social distancing.


Subject(s)
Betacoronavirus , Coronavirus Infections/physiopathology , Kidney Transplantation/adverse effects , Pneumonia, Viral/physiopathology , Coronavirus Infections/complications , Diarrhea/etiology , Fatigue/etiology , Female , Humans , Middle Aged , Organ Transplantation , Pandemics , Pneumonia, Viral/complications , Transplant Recipients
19.
Pediatr Infect Dis J ; 39(11): 1040-1042, 2020 11.
Article in English | MEDLINE | ID: covidwho-710560

ABSTRACT

Since December 2019, severe acute respiratory syndrome coronavirus 2 infection has spread worldwide. We all are concerned about immunocompromised children, especially hematologic and oncologic pediatric patients. We want to share our experience with 2 pediatric cancer patients with severe acute respiratory syndrome coronavirus 2 infection. Both presented mild disease and good outcome. No respiratory symptoms were identified, but both developed diarrhea, one probably secondary to lopinavir/ritonavir. Pediatric cancer patients may have milder disease than adults, but larger studies are needed to make conclusions.


Subject(s)
Coronavirus Infections/diagnosis , Kidney Neoplasms/virology , Pneumonia, Viral/diagnosis , Sarcoma, Ewing/virology , Wilms Tumor/virology , Adolescent , Betacoronavirus/isolation & purification , Child , Child, Preschool , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Diarrhea/etiology , Diarrhea/virology , Female , Humans , Kidney Neoplasms/epidemiology , Lopinavir/therapeutic use , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Ritonavir/therapeutic use , Sarcoma, Ewing/epidemiology , Spain/epidemiology , Wilms Tumor/epidemiology
20.
J Coll Physicians Surg Pak ; 30(6): 40-42, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-690668

ABSTRACT

Coronavirus disease 19 (COVID-19) is a viral pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease started as an epidemic in China in December 2019 that later achieved a pandemic potential spreading to over 210 countries with more than 3.5 million confirmed cases and close to 250,000 deaths till date. Its symptoms most commonly include, dry cough, fever, myalgia, and fatigue. As the number of new cases keeps on rising, many patients have been documented with gastrointestinal manifestations such as diarrhoea, vomiting and abdominal pain. We report a case of a 23-year-old female who presented with the primary complaint of diarrhoea, after positive contact history with a COVID-19 patient. Key Words: SARS-CoV-2, COVID-19, Pneumonia, ARDS, Diarrhoea.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , Diarrhea/etiology , Pneumonia, Viral/diagnosis , Azithromycin/therapeutic use , Betacoronavirus , Coronavirus/genetics , Coronavirus Infections/drug therapy , Cough/etiology , Female , Fever/etiology , Humans , Hydroxychloroquine/therapeutic use , Pandemics/prevention & control , Pneumonia, Viral/drug therapy , Reverse Transcriptase Polymerase Chain Reaction , Treatment Outcome , Young Adult
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