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1.
PLoS Negl Trop Dis ; 16(4): e0010357, 2022 04.
Article in English | MEDLINE | ID: covidwho-1854982

ABSTRACT

BACKGROUND: Scrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear. METHODS: Clinical and epidemiological data of ST patients were collected in 55 surveillance hospitals located in Guangzhou City, China, from 2012 to 2018. Severe prognosis and related factors were determined and compared between pediatric and elderly patients. RESULTS: A total of 2,074 ST patients including 209 pediatric patients and 1,865 elderly patients were included, with a comparable disease severity rate of 11.0% (95% CI 7.1%-16.1%) and 10.3% (95% CI 9.0%-11.8%). Different frequencies of clinical characteristics including lymphadenopathy, skin rash, enlarged tonsils, etc. were observed between pediatric and elderly patients. Presence of peripheral edema and decreased hemoglobin were the most important predictors of severe illness in pediatric patients with adjusted ORs by 38.99 (9.96-152.67, p<0.001) and 13.22 (1.54-113.50, p = 0.019), respectively, while presence of dyspnea and increased total bilirubin were the potential determinants of severe disease in elderly patients with adjusted ORs by 11.69 (7.33-18.64, p<0.001) and 3.17 (1.97-5.11, p<0.001), respectively. Compared with pediatric patients, elderly patients were more likely to receive doxycycline (64.8% v.s 9.9%, p<0.001), while less likely to receive azithromycin therapy (5.0% v.s 41.1%, p<0.001). CONCLUSION: The disease severity rate is comparable between pediatric and elderly ST patients, while different clinical features and laboratory indicators were associated with development of severe complications for pediatric and elderly patients, which is helpful for diagnosis and progress assessment of disease for ST patients.


Subject(s)
Scrub Typhus , Aged , Child , China/epidemiology , Doxycycline/therapeutic use , Humans , Risk Factors , Scrub Typhus/complications , Scrub Typhus/drug therapy , Scrub Typhus/epidemiology , Severity of Illness Index
2.
J Infect Public Health ; 15(5): 566-572, 2022 May.
Article in English | MEDLINE | ID: covidwho-1763843

ABSTRACT

An unprecedented global health crisis has developed due to the emergence of the mysterious coronavirus-2 of the severe acute respiratory syndrome, which has resulted in millions of deaths around the globe, as no therapy could control the 'cytokine storm'. Consequently, many vaccines have been developed and several others are being developed for this infection. Although most of the approved vaccines have been highly effective, many developing, and economically poor countries are still deprived of vaccination against SARS-CoV-2 due to the unequal distribution of vaccines worldwide. Furthermore, the uncertainty about the effectiveness of the available vaccines against the emerging mutants and variants also remains a matter of concern. Due to the multistep pathogenesis and unique features, combination therapy using safe immunomodulatory and antiviral drugs should be considered as the most effective and acceptable therapeutic regimen for this infection. Based on a thorough assessment of the literature, it was determined that it would be interesting to study the therapeutic potential of ivermectin and doxycycline, given their roles in several biological pathways involved in SARS CoV-2 pathogenesis. Following that, a comprehensive literature search was undertaken using Scopus, Web of Science, and Pubmed, depending on the inclusion and exclusion criteria. The present study provides a mechanism and comprehensive report, highlighting the role of combined therapy with ivermectin and doxycycline in alleviating the 'cytokine storm' of COVID-19 infection.


Subject(s)
COVID-19 , Cytokine Release Syndrome , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/prevention & control , Doxycycline/therapeutic use , Humans , Ivermectin/therapeutic use , SARS-CoV-2 , Vaccination
3.
Rev Med Virol ; 31(6): e2221, 2021 11.
Article in English | MEDLINE | ID: covidwho-1575100

ABSTRACT

The current pandemic caused by SARS-CoV-2 virus infection is known as Covid-19 (coronavirus disease 2019). This disease can be asymptomatic or can affect multiple organ systems. Damage induced by the virus is related to dysfunctional activity of the immune system, but the activity of molecules such as C-reactive protein (CRP) as a factor capable of inducing an inflammatory status that may be involved in the severe evolution of the disease, has not been extensively evaluated. A systematic review was performed using the NCBI-PubMed database to find articles related to Covid-19 immunity, inflammatory response, and CRP published from December 2019 to December 2020. High levels of CRP were found in patients with severe evolution of Covid-19 in which several organ systems were affected and in patients who died. CRP activates complement, induces the production of pro-inflammatory cytokines and induces apoptosis which, together with the inflammatory status during the disease, can lead to a severe outcome. Several drugs can decrease the level or block the effect of CRP and might be useful in the treatment of Covid-19. From this review it is reasonable to conclude that CRP is a factor that can contribute to severe evolution of Covid-19 and that the use of drugs able to lower CRP levels or block its activity should be evaluated in randomized controlled clinical trials.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , C-Reactive Protein/antagonists & inhibitors , COVID-19/drug therapy , Complement System Proteins/immunology , Cytokine Release Syndrome/drug therapy , SARS-CoV-2/pathogenicity , ADAM17 Protein/antagonists & inhibitors , ADAM17 Protein/genetics , ADAM17 Protein/immunology , Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Angiotensin-Converting Enzyme 2/genetics , Angiotensin-Converting Enzyme 2/immunology , Biomarkers/blood , C-Reactive Protein/genetics , C-Reactive Protein/immunology , COVID-19/immunology , COVID-19/pathology , COVID-19/virology , Celecoxib/therapeutic use , Complement System Proteins/genetics , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/pathology , Cytokine Release Syndrome/virology , Cytokines/antagonists & inhibitors , Cytokines/genetics , Cytokines/immunology , Disease Progression , Doxycycline/therapeutic use , Gene Expression Regulation , Humans , Randomized Controlled Trials as Topic , Severity of Illness Index , Survival Analysis
4.
BMJ Case Rep ; 14(10)2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1447986

ABSTRACT

An 80-year-old man with no personal or family history of bleeding, presented to hospital with extensive haematomas and skin bruising after using doxycycline. His basic lab workup was concerning for a coagulopathy with an elevated activated partial thromboplastin time and significant anaemia. Mixing studies and other factor levels were tested that led to the diagnosis of acquired haemophilia A with low factor VIII levels and high factor VIII antibodies. He was started on steroids, but his haemoglobin level continued to drop. Later, during his treatment, he was given multiple therapeutic agents, including cyclophosphamide, rituximab and recombinant factor VII (NovoSeven-R). Gradually factor VIII levels increased and haemoglobin stabilised. The hospital course was complicated by COVID-19 pneumonia leading to acute respiratory distress syndrome; the patient eventually expired due to respiratory failure.


Subject(s)
COVID-19 , Hemophilia A , Aged, 80 and over , Doxycycline/therapeutic use , Hemophilia A/chemically induced , Hemophilia A/diagnosis , Hemophilia A/drug therapy , Humans , Male , Partial Thromboplastin Time , SARS-CoV-2
5.
Expert Rev Proteomics ; 18(8): 707-717, 2021 08.
Article in English | MEDLINE | ID: covidwho-1380972

ABSTRACT

INTRODUCTION: Active matrix metalloproteinase (aMMP)-8 utilized in point-of-care testing (POCT) is regarded as a potential biomarker for periodontal and peri-implant diseases. Various host and microbial factors eventually influence the expression, degranulation, levels and activation of aMMP-8. The type of oral fluids (saliva, mouthrinse, gingival crevicular, and peri-implant sulcular fluids [GCF/PISF], respectively) affect the analysis. AREAS COVERED: With this background, we aimed to review here the recent studies on practical, inexpensive, noninvasive and quantitative mouthrinse and GCF/PISF chair-side POCT lateral flow aMMP-8 immunoassays (PerioSafe and ImplantSafe/ORALyzer) and how they help to detect, predict, monitor the course, treatment and prevention of periodontitis and peri-implantitis. The correlations of aMMP-8 POCT to other independent and catalytic activity assays of MMP-8 are also addressed. EXPERT OPINION: The mouthrinse aMMP-8 POCT can also detect prediabetes/diabetes and tissue destructive oral side-effects due to the head and neck cancers' radiotherapy. Chlorhexidine and doxycycline can inhibit collagenolytic human neutrophil and GCF aMMP-8. Furthermore, by a set of case-series we demonstrate the potential of mouthrinse aMMP-8 POCT to real-time/online detect periodontitis as a potential risk disease for coronavirus disease 2019 (COVID-19). The clinical interdisciplinary utilization of aMMP-8 POCT requires additional oral, medical, and interdisciplinary studies.


Subject(s)
COVID-19/enzymology , Matrix Metalloproteinase 8/metabolism , Pandemics , SARS-CoV-2 , Biomarkers/analysis , Biomarkers/metabolism , COVID-19/complications , COVID-19/drug therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/enzymology , Doxycycline/therapeutic use , Humans , Immunoassay/methods , Matrix Metalloproteinase 8/analysis , Mouthwashes , Oral Hygiene , Peri-Implantitis/diagnosis , Peri-Implantitis/enzymology , Periodontitis/complications , Periodontitis/diagnosis , Periodontitis/enzymology , Point-of-Care Testing , Radiotherapy/adverse effects , Risk Factors
8.
Hosp Pediatr ; 11(4): e61-e65, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1327994

ABSTRACT

Multisystem inflammatory syndrome in children (MIS-C) is an emerging disease described in children in association with infection or epidemiological link to severe acute respiratory syndrome coronavirus 2. Signs and symptoms include fever, rash, and cardiac dysfunction; US Centers for Disease Control and Prevention have put forth broad criteria for diagnosis. The illness is serious and can progress rapidly to heart failure and death. However, findings in MIS-C are nonspecific, and there is significant overlap with other systemic illnesses, including Kawasaki disease and several viral and bacterial infections. We present 5 children admitted to a teaching hospital within an 11-day period in May 2020 for MIS-C evaluation who were later diagnosed with murine typhus. Typhus is a rickettsial infection that presents with fever and rash, and, although usually self-limited, responds well to treatment with doxycycline to shorten the course of illness. Clinical and laboratory characteristics of these children are presented to illustrate similarities to MIS-C, which can also be shared with viral, bacterial, or other regional endemic infections, as well as noninfectious inflammatory diseases. This case series serves to remind pediatric hospitalists to be vigilant to avoid premature closure on MIS-C for children admitted with fever and systemic inflammation. Maintaining a wide differential diagnosis in approaching such patients is of utmost importance as community exposure to severe acute respiratory syndrome coronavirus 2 is likely and evidence of past infection becomes commonplace.


Subject(s)
COVID-19/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Typhus, Endemic Flea-Borne/diagnosis , Adolescent , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Child , Diagnosis, Differential , Doxycycline/therapeutic use , Female , Humans , Male , Typhus, Endemic Flea-Borne/drug therapy
9.
JAMA ; 325(18): 1841-1851, 2021 05 11.
Article in English | MEDLINE | ID: covidwho-1237391

ABSTRACT

Importance: Alteration in lung microbes is associated with disease progression in idiopathic pulmonary fibrosis. Objective: To assess the effect of antimicrobial therapy on clinical outcomes. Design, Setting, and Participants: Pragmatic, randomized, unblinded clinical trial conducted across 35 US sites. A total of 513 patients older than 40 years were randomized from August 2017 to June 2019 (final follow-up was January 2020). Interventions: Patients were randomized in a 1:1 allocation ratio to receive antimicrobials (n = 254) or usual care alone (n = 259). Antimicrobials included co-trimoxazole (trimethoprim 160 mg/sulfamethoxazole 800 mg twice daily plus folic acid 5 mg daily, n = 128) or doxycycline (100 mg once daily if body weight <50 kg or 100 mg twice daily if ≥50 kg, n = 126). No placebo was administered in the usual care alone group. Main Outcomes and Measures: The primary end point was time to first nonelective respiratory hospitalization or all-cause mortality. Results: Among the 513 patients who were randomized (mean age, 71 years; 23.6% women), all (100%) were included in the analysis. The study was terminated for futility on December 18, 2019. After a mean follow-up time of 13.1 months (median, 12.7 months), a total of 108 primary end point events occurred: 52 events (20.4 events per 100 patient-years [95% CI, 14.8-25.9]) in the usual care plus antimicrobial therapy group and 56 events (18.4 events per 100 patient-years [95% CI, 13.2-23.6]) in the usual care group, with no significant difference between groups (adjusted HR, 1.04 [95% CI, 0.71-1.53; P = .83]. There was no statistically significant interaction between the effect of the prespecified antimicrobial agent (co-trimoxazole vs doxycycline) on the primary end point (adjusted HR, 1.15 [95% CI 0.68-1.95] in the co-trimoxazole group vs 0.82 [95% CI, 0.46-1.47] in the doxycycline group; P = .66). Serious adverse events occurring at 5% or greater among those treated with usual care plus antimicrobials vs usual care alone included respiratory events (16.5% vs 10.0%) and infections (2.8% vs 6.6%); adverse events of special interest included diarrhea (10.2% vs 3.1%) and rash (6.7% vs 0%). Conclusions and Relevance: Among adults with idiopathic pulmonary fibrosis, the addition of co-trimoxazole or doxycycline to usual care, compared with usual care alone, did not significantly improve time to nonelective respiratory hospitalization or death. These findings do not support treatment with these antibiotics for the underlying disease. Trial Registration: ClinicalTrials.gov Identifier: NCT02759120.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Idiopathic Pulmonary Fibrosis/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Aged , Anti-Bacterial Agents/adverse effects , Doxycycline/adverse effects , Female , Hospitalization , Humans , Idiopathic Pulmonary Fibrosis/mortality , Lung/microbiology , Male , Middle Aged , Respiratory Function Tests , Respiratory Tract Infections/prevention & control , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects
10.
J Int Med Res ; 49(5): 3000605211013550, 2021 May.
Article in English | MEDLINE | ID: covidwho-1226829

ABSTRACT

OBJECTIVE: We evaluated whether ivermectin combined with doxycycline reduced the clinical recovery time in adults with COVID-19 infection. METHODS: This was a randomized, blinded, placebo-controlled trial in patients with mild-to-moderate COVID-19 symptoms randomly assigned to treatment (n = 200) and placebo (n = 200) groups. The primary outcome was duration from treatment to clinical recovery. Secondary outcomes were disease progression and persistent COVID-19 positivity by RT-PCR. RESULTS: Among 556 screened patients, 400 were enrolled and 363 completed follow-up. The mean patient age was 40 years, and 59% were men. The median recovery time was 7 (4-10, treatment group) and 9 (5-12, placebo group) days (hazard ratio, 0.73; 95% confidence interval, 0.60-0.90). The number of patients with a ≤7-day recovery was 61% (treatment group) and 44% (placebo groups) (hazard ratio, 0.06; 95% confidence interval, 0.04-0.09). The proportion of patients who remained RT-PCR positive on day 14 and whose disease did not progress was significantly lower in the treatment group than in the placebo group. CONCLUSIONS: Patients with mild-to-moderate COVID-19 infection treated with ivermectin plus doxycycline recovered earlier, were less likely to progress to more serious disease, and were more likely to be COVID-19 negative by RT-PCR on day 14. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04523831. DATA REPOSITORY ID: Dryad. doi:10.5061/dryad.qjq2bvqf6.


Subject(s)
COVID-19 , Ivermectin , Adult , Doxycycline/therapeutic use , Female , Humans , Ivermectin/therapeutic use , Male , SARS-CoV-2 , Treatment Outcome
11.
Pulm Pharmacol Ther ; 67: 102008, 2021 04.
Article in English | MEDLINE | ID: covidwho-1129172

ABSTRACT

Coronavirus virus disease 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), actually considered as a global pandemic. The entry-point for SARS-CoV-2 is angiotensin converting enzyme 2 (ACE2) and dipeptidyl peptidase 4 (DPP4), which are highly expressed in the lung. Among other complications, COVID-19leads to fatal pneumonia, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) due to development of cytokine storm (CS). The pathogenesis of SARS-CoV-2 infection depends on the viral load and human innate/adaptive immune response that are required for viral elimination in the first phase of COVID-19. However, an exaggerated immune response in the second phase of COVID-19 results in immune overreaction and CS-induced ALI and ARDS. Thus, in view of these considerations, we report here a series of five patients with COVID-19 pneumonia who developed ALI. In addition to the supportive therapy, the patients received doxycycline in the first week and doxycycline plus colchicine in the second week. Following sequential therapy with doxycycline and/or colchicine in patients with COVID-19 pneumonia, the patients had reduction of disease severity and symptoms with better clinical and radiological outcomes. However, it is tough to confirm the link between this therapeutic combination and recovery from COVID-19 pneumonia, as it is a small case-series report. Nevertheless, this study gives a rational for large-scale prospective studies to evaluate the dual sequential effect of doxycycline and colchicine on the COVID-19 severity. This case-series illustrated that use of colchicine: doxycycline combination is linked with marked improvements in the clinical, laboratory and radiological outcomes in patients with COVID-19 pneumonia. However, we cannot sketch any definitive conclusion from our observation, despite we hypothesize that this combination therapeutic regimen may attenuate and treat COVID-19. Further, namely prospective, randomized, and controlled clinical studies are recommended in this regard.


Subject(s)
COVID-19/drug therapy , Colchicine/therapeutic use , Doxycycline/therapeutic use , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Drug Combinations , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2/isolation & purification
12.
Drug Discov Ther ; 15(1): 39-41, 2021 Mar 10.
Article in English | MEDLINE | ID: covidwho-1094314

ABSTRACT

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which began in Wuhan, China in December 2019, has rapidly spread all over the world. The World Health Organization characterized the disease caused by SARS-CoV-2 (COVID-19) as a pandemic in March 2020. In the absence of specific treatments for the virus, treatment options are being examined. Drug repurposing is a process of identifying new therapeutic uses for approved drugs. It is an effective strategy to discover drug molecules with new therapeutic indications. This strategy is time-saving, low-cost, and has a minimal risk of failure. Several existing approved drugs such as chloroquine, hydroxychloroquine, doxycycline, azithromycin, and ivermectin are currently in use because of their efficacy in inhibiting COVID-19. Multidrug therapy, such as a combination of hydroxychloroquine and azithromycin, a combination of doxycycline and ivermectin, or a combination of ivermectin, doxycycline, and azithromycin, has been successfully administered. Multidrug therapy is efficacious because the mechanisms of action of these drugs differ. Moreover, multidrug therapy may prevent the emergence of drug-resistant SARS-CoV-2.


Subject(s)
COVID-19/drug therapy , Drug Therapy, Combination/methods , Azithromycin/therapeutic use , Doxycycline/therapeutic use , Drug Repositioning , Humans , Hydroxychloroquine/therapeutic use , Ivermectin/therapeutic use , Treatment Outcome
13.
BMJ Case Rep ; 14(1)2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-1032286

ABSTRACT

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.


Subject(s)
COVID-19/complications , Pulmonary Embolism/etiology , Venous Thrombosis/etiology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Antiparasitic Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/blood , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/therapy , Computed Tomography Angiography , Diabetes Mellitus, Type 2/complications , Doxycycline/therapeutic use , Femoral Vein , Fibrin Fibrinogen Degradation Products , Glucocorticoids/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Ivermectin/therapeutic use , Male , Methylprednisolone/therapeutic use , Middle Aged , Oxygen Inhalation Therapy , Popliteal Vein , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/therapy , SARS-CoV-2 , Tomography, X-Ray Computed , Ultrasonography, Doppler, Color , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapy
15.
Expert Rev Anti Infect Ther ; 19(8): 1001-1008, 2021 08.
Article in English | MEDLINE | ID: covidwho-978558

ABSTRACT

Introduction: COVID-19 infection with no known-specific drugs or vaccines has impacted mankind and has become beyond precedence. Currently, re-purposing of existing drugs is the only therapeutic option for managing COVID-19 symptoms and associated co-infections to reduce mortality. Antimicrobials as varied as antiparasitic, antiviral, and antibiotics are under various stages of evaluation.Areas covered: Recently, doxycycline, a broad-spectrum antibiotic that has also reported antiviral and anti-inflammatory properties was widely investigated in clinical trials, either alone or in combination with other drugs, and repurposed for COVID-19 treatment. In the review, the potential therapeutic applications of doxycycline in COVID-19 treatment and its potential adverse implications with respect to antimicrobial resistance bestowed by repurposing the antibiotic have been expounded.Expert opinion: 'Fighting disease with already existing antibiotics' and 'antimicrobial resistance progression' are like two arms of a balance that has to be carefully equilibrated. Any imbalance by the inappropriate or indiscriminate use of the repurposed drugs would cause a disastrous increase in antimicrobial resistance (AMR). Hence, cautious parallel assessment of potential long-term consequences of AMR is of great importance to mankind as its impacts would prevail even after the current pandemic.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Doxycycline/therapeutic use , Drug Repositioning , Anti-Bacterial Agents/adverse effects , Antiviral Agents/adverse effects , Doxycycline/adverse effects , Humans , Pandemics
16.
Respiration ; 99(12): 1145-1153, 2020.
Article in English | MEDLINE | ID: covidwho-975754

ABSTRACT

Treatment with immunomodulators, such as intravenous immunoglobulin (IVIG), may attenuate inflammatory responses observed in the severe stages of acute respiratory distress syndrome (ARDS) caused by coronavirus disease 19 (COVID-19). We retrospectively evaluated the clinical courses of 12 COVID-19 patients who received IVIG at various stages of their illness, including within the first 72 h of clinical presentation, after initiation of mechanical ventilation, and after prolonged ventilation and ICU stay. The patients included 9 men and 3 women with a median age of 50 years (range 23-74), median Charlson Comorbidity Score of 2 (range 0-7), and median Acute Physiology and Chronic Health Evaluation Score of 13 (range 5-33) at the time of IVIG. The IVIG total dose ranged from 0.5 to 2.0 g/kg (median 1.25 g/kg) distributed over 1-4 daily doses. The most common regimen received was 0.5 g/kg daily for 3 days. The median time to IVIG administration was 9 days (range 0-48 days) after admission. The median time from first IVIG dose administration to hospital discharge was 14 days (range 3-48). The 5 patients who received IVIG ≤4 days of admission demonstrated a significantly shorter length of hospital stay after treatment (median 7 days, range 3-14 days) than the 7 patients who received it >7 days after admission (median 33 days, range 8-48 days, p = 0.03, Mann-Whitney U test). These cases demonstrate that IVIG may improve the clinical state of patients with moderate to severe COVID-19 infection. Despite very high illness severity scores, all patients survived hospital discharge. No thrombotic events occurred and IVIG was well tolerated, despite most cases demonstrating very elevated D-dimer suggestive of active intravascular fibrinolysis. We believe that IVIG warrants immediate clinical trial evaluation in COVID-19 to confirm its role as a mainstay treatment of moderate to severe COVID-19 infection as a means to reduce hospital stay and utilization of ICU resources, including mechanical ventilation, and potentially reduce mortality.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Intensive Care Units , Length of Stay , Respiration, Artificial , APACHE , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Alanine/analogs & derivatives , Alanine/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/drug therapy , Doxycycline/therapeutic use , Enzyme Inhibitors/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Lopinavir/therapeutic use , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Time Factors , Young Adult
18.
Pediatr Blood Cancer ; 67(11): e28579, 2020 11.
Article in English | MEDLINE | ID: covidwho-746153

ABSTRACT

New York City has emerged as one of the epicenters of the SARS-COV-2 pandemic, with the Bronx being disproportionately affected. This novel coronavirus has caused significant respiratory manifestations raising the concern for development of acute chest syndrome (ACS) in patients with sickle cell disease (SCD). We report a series of pediatric SCD SARS-COV-2-positive patients admitted with ACS. SARS-COV-2-positive SCD patients, who did not develop ACS, were the comparison group. Hydroxyurea use (P-value = .02) and lower absolute monocyte counts (P-value = .04) were noted in patients who did not develop ACS. These preliminary findings need to be further evaluated in larger cohorts.


Subject(s)
Acute Chest Syndrome/complications , Anemia, Sickle Cell/complications , COVID-19/complications , Acute Chest Syndrome/diagnosis , Acute Chest Syndrome/drug therapy , Adolescent , Anemia, Sickle Cell/drug therapy , Anti-Bacterial Agents/therapeutic use , Antisickling Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19 Testing , Child , Doxycycline/therapeutic use , Female , Hospitals, Urban , Humans , Hydroxyurea/therapeutic use , Male , New York City , Polymerase Chain Reaction , SARS-CoV-2 , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
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