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1.
BMC Cardiovasc Disord ; 21(1): 528, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1505900

ABSTRACT

BACKGROUND: The value of mechanical circulatory support (MCS) in cardiogenic shock, especially the combination of the ECMELLA approach (Impella combined with ECMO), remains controversial. CASE PRESENTATION: A previously healthy 33-year-old female patient was submitted to a local emergency department with a flu-like infection and febrile temperatures up to 39 °C. The patient was tested positive for type-A influenza, however negative for SARS-CoV-2. Despite escalated invasive ventilation, refractory hypercapnia (paCO2: 22 kPa) with severe respiratory acidosis (pH: 6.9) and a rising norepinephrine rate occurred within a few hours. Due to a Horovitz-Index < 100, out-of-centre veno-venous extracorporeal membrane oxygenation (vv-ECMO)-implantation was performed. A CT-scan done because of anisocoria revealed an extended dissection of the right vertebral artery. While the initial left ventricular function was normal, echocardiography revealed severe global hypokinesia. After angiographic exclusion of coronary artery stenoses, we geared up LV unloading by additional implantation of an Impella CP and expanded the vv-ECMO to a veno-venous-arterial ECMO (vva-ECMO). Clinically relevant bleeding from the punctured femoral arteries resulted in massive transfusion and was treated by vascular surgery later on. Under continued MCS, LVEF increased to approximately 40% 2 days after the initiation of ECMELLA. After weaning, the Impella CP was explanted at day 5 and the vva-ECMO was removed on day 9, respectively. The patient was discharged in an unaffected neurological condition to rehabilitation 25 days after the initial admission. CONCLUSIONS: This exceptional case exemplifies the importance of aggressive MCS in severe cardiogenic shock, which may be especially promising in younger patients with non-ischaemic cardiomyopathy and potentially reversible causes of cardiogenic shock. This case impressively demonstrates that especially young patients may achieve complete neurological restoration, even though the initial prognosis may appear unfavourable.


Subject(s)
Extracorporeal Membrane Oxygenation/methods , Heart-Assist Devices , Influenza A virus/isolation & purification , Influenza, Human , Respiration, Artificial/methods , Respiratory Insufficiency , Ventricular Dysfunction, Left , Adult , COVID-19/diagnosis , Clinical Deterioration , Critical Care/methods , Echocardiography/methods , Female , Heart Failure/physiopathology , Heart Failure/therapy , Humans , Influenza, Human/complications , Influenza, Human/diagnosis , Influenza, Human/physiopathology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Serologic Tests/methods , Severity of Illness Index , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/therapy , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/therapy
2.
Acta Med Acad ; 49(2): 130-143, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-1414828

ABSTRACT

In this review, we discuss the latest developments in research pertaining to virus-induced asthma exacerbations and consider recent advances in treatment options. Asthma is a chronic disease of the airways that continues to impose a substantial clinical burden worldwide. Asthma exacerbations, characterised by an acute deterioration in respiratory symptoms and airflow obstruction, are associated with significant morbidity and mortality. These episodes are most commonly triggered by respiratory virus infections. The mechanisms underlying the pathogenesis of virus-induced exacerbations have been the focus of extensive biomedical research. Developing a robust understanding of the interplay between respiratory viruses and the host immune response will be critical for developing more efficacious, targeted therapies for exacerbations. CONCLUSION: There has been significant recent progress in our understanding of the mechanisms underlying virus-induced airway inflammation in asthma and these advances will underpin the development of future clinical therapies.


Subject(s)
Anti-Asthmatic Agents/therapeutic use , Antiviral Agents/therapeutic use , Asthma/drug therapy , Respiratory Tract Infections/drug therapy , Virus Diseases/drug therapy , Adenovirus Infections, Human/drug therapy , Adenovirus Infections, Human/immunology , Adenovirus Infections, Human/physiopathology , Administration, Inhalation , Asthma/immunology , Asthma/physiopathology , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Disease Progression , Humans , Influenza, Human/drug therapy , Influenza, Human/immunology , Influenza, Human/physiopathology , Interferon-beta/therapeutic use , Macrolides/therapeutic use , Omalizumab/therapeutic use , Paramyxoviridae Infections/drug therapy , Paramyxoviridae Infections/immunology , Paramyxoviridae Infections/physiopathology , Picornaviridae Infections/drug therapy , Picornaviridae Infections/immunology , Picornaviridae Infections/physiopathology , Respiratory Syncytial Virus Infections/drug therapy , Respiratory Syncytial Virus Infections/immunology , Respiratory Syncytial Virus Infections/physiopathology , Respiratory Tract Infections/immunology , Respiratory Tract Infections/physiopathology , Virus Diseases/immunology , Virus Diseases/physiopathology
5.
Nature ; 594(7862): 259-264, 2021 06.
Article in English | MEDLINE | ID: covidwho-1275936

ABSTRACT

The acute clinical manifestations of COVID-19 have been well characterized1,2, but the post-acute sequelae of this disease have not been comprehensively described. Here we use the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6-month incident sequelae-including diagnoses, medication use and laboratory abnormalities-in patients with COVID-19 who survived for at least 30 days after diagnosis. We show that beyond the first 30 days of illness, people with COVID-19 exhibit a higher risk of death and use of health resources. Our high-dimensional approach identifies incident sequelae in the respiratory system, as well as several other sequelae that include nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We show increased incident use of several therapeutic agents-including pain medications (opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive and oral hypoglycaemic agents-as well as evidence of laboratory abnormalities in several organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient that increases according to the severity of the acute COVID-19 infection (that is, whether patients were not hospitalized, hospitalized or admitted to intensive care). Our findings show that a substantial burden of health loss that spans pulmonary and several extrapulmonary organ systems is experienced by patients who survive after the acute phase of COVID-19. These results will help to inform health system planning and the development of multidisciplinary care strategies to reduce chronic health loss among individuals with COVID-19.


Subject(s)
COVID-19/complications , SARS-CoV-2/pathogenicity , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/physiopathology , COVID-19/psychology , Cohort Studies , Databases, Factual , Datasets as Topic , Electronic Health Records , Female , Hospitalization/statistics & numerical data , Humans , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Influenza, Human/physiopathology , Male , Outpatients/psychology , Outpatients/statistics & numerical data , Risk , Time Factors , United States , United States Department of Veterans Affairs
6.
Commun Biol ; 4(1): 480, 2021 04 13.
Article in English | MEDLINE | ID: covidwho-1182874

ABSTRACT

The relationship between gut microbes and COVID-19 or H1N1 infections is not fully understood. Here, we compared the gut mycobiota of 67 COVID-19 patients, 35 H1N1-infected patients and 48 healthy controls (HCs) using internal transcribed spacer (ITS) 3-ITS4 sequencing and analysed their associations with clinical features and the bacterial microbiota. Compared to HCs, the fungal burden was higher. Fungal mycobiota dysbiosis in both COVID-19 and H1N1-infected patients was mainly characterized by the depletion of fungi such as Aspergillus and Penicillium, but several fungi, including Candida glabrata, were enriched in H1N1-infected patients. The gut mycobiota profiles in COVID-19 patients with mild and severe symptoms were similar. Hospitalization had no apparent additional effects. In COVID-19 patients, Mucoromycota was positively correlated with Fusicatenibacter, Aspergillus niger was positively correlated with diarrhoea, and Penicillium citrinum was negatively correlated with C-reactive protein (CRP). In H1N1-infected patients, Aspergillus penicilloides was positively correlated with Lachnospiraceae members, Aspergillus was positively correlated with CRP, and Mucoromycota was negatively correlated with procalcitonin. Therefore, gut mycobiota dysbiosis occurs in both COVID-19 patients and H1N1-infected patients and does not improve until the patients are discharged and no longer require medical attention.


Subject(s)
COVID-19/physiopathology , Dysbiosis/microbiology , Gastrointestinal Microbiome/physiology , Influenza, Human/physiopathology , Adult , Aged , Bacteria/classification , Bacteria/genetics , COVID-19/virology , Feces/microbiology , Female , Fungi/classification , Fungi/genetics , Gastrointestinal Microbiome/genetics , Humans , Influenza A Virus, H1N1 Subtype/physiology , Influenza, Human/virology , Male , Middle Aged , SARS-CoV-2/physiology , Sequence Analysis, DNA/methods
7.
Front Cell Infect Microbiol ; 11: 638852, 2021.
Article in English | MEDLINE | ID: covidwho-1170078

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged in December 2019 and rapidly outspread worldwide endangering human health. The coronavirus disease 2019 (COVID-19) manifests itself through a wide spectrum of symptoms that can evolve to severe presentations as pneumonia and several non-respiratory complications. Increased susceptibility to COVID-19 hospitalization and mortality have been linked to associated comorbidities as diabetes, hypertension, cardiovascular diseases and, recently, to obesity. Similarly, individuals living with obesity are at greater risk to develop clinical complications and to have poor prognosis in severe influenza pneumonia. Immune and metabolic dysfunctions associated with the increased susceptibility to influenza infection are linked to obesity-associated low-grade inflammation, compromised immune and endocrine systems, and to high cardiovascular risk. These preexisting conditions may favor virological persistence, amplify immunopathological responses and worsen hemodynamic instability in severe COVID-19 as well. In this review we highlight the main factors and the current state of the art on obesity as risk factor for influenza and COVID-19 hospitalization, severe respiratory manifestations, extrapulmonary complications and even death. Finally, immunoregulatory mechanisms of severe influenza pneumonia in individuals with obesity are addressed as likely factors involved in COVID-19 pathophysiology.


Subject(s)
Body Weight , COVID-19/immunology , Immunity , Influenza, Human/immunology , Obesity/immunology , Adipokines , Adipose Tissue , Animals , COVID-19/physiopathology , Comorbidity , Diabetes Mellitus , Endotoxemia , Heart Disease Risk Factors , Hospitalization , Humans , Hyperglycemia , Inflammation , Influenza, Human/physiopathology , Metabolic Syndrome , Obesity/complications , Orthomyxoviridae Infections/immunology , Risk Factors , SARS-CoV-2
8.
Front Public Health ; 9: 628479, 2021.
Article in English | MEDLINE | ID: covidwho-1154263

ABSTRACT

Background: COVID-19 has caused a global public health emergency. Government mitigation strategies included a series of behavior-based prevention policies that had a likely impact on the spread of other contagious respiratory illnesses, such as seasonal influenza. Our aim was to explore how 2019-2020 influenza tracked onto COVID-19 pandemic and its mitigation methods. Materials and Methods: We linked the WHO FluNet database and COVID-19 confirmed cases (Johns Hopkins University) for four countries across the northern (Canada, the United States) and southern hemispheres (Australia, Brazil) for the period 2016-2020. Graphical presentations of longitudinal data were provided. Results: There was a notable reduction in influenza cases for the 2019-2020 season. Northern hemisphere countries experienced a quicker ending to the 2019-2020 seasonal influenza cases (shortened by 4-7 weeks) and virtually no 2020 fall influenza season. Countries from the southern hemisphere experienced drastically low levels of seasonal influenza, with consistent trends that were approaching zero cases after the introduction of COVID-19 measures. Conclusions: It is likely that the COVID-19 mitigation measures played a notable role in the marked decrease in influenza, with little to no influenza activity in both the northern and southern hemispheres. In spite of this reduction in influenza cases, there was still community spread of COVID-19, highlighting the contagiousness of SARS-CoV-2 compared to influenza. These results, together with the higher mortality rate from SARS-CoV-2 compared to influenza, highlight that COVID-19 is a far greater health threat than influenza.


Subject(s)
COVID-19/epidemiology , COVID-19/physiopathology , Influenza, Human/epidemiology , Influenza, Human/physiopathology , Internationality , Pandemics/statistics & numerical data , Symptom Assessment/statistics & numerical data , Australia/epidemiology , Brazil/epidemiology , Canada/epidemiology , Female , Humans , Male , Public Health/statistics & numerical data , SARS-CoV-2 , United States/epidemiology
9.
Front Public Health ; 9: 616963, 2021.
Article in English | MEDLINE | ID: covidwho-1106063

ABSTRACT

Background: This study was to collect clinical features and computed tomography (CT) findings of Influenza-Like Illness (ILI) cases, and to evaluate the correlation between clinical data and the abnormal chest CT in patients with the Influenza-Like Illness symptoms. Methods: Patients with the Influenza-Like Illness symptoms who attended the emergency department of The Six Medical Center of The PLA General Hospital from February 10 to April 1, 2020 were enrolled. Clinical and imaging data of the enrolled patients were collected and analyzed. The association between clinical characteristics and abnormal chest CT was also analyzed. Results: A total of 148 cases were enrolled in this study. Abnormalities on chest CT were detected in 61/148 (41.2%) patients. The most common abnormal CT features were as follows: patchy consolidation 22/61(36.1%), ground-glass opacities 21/61(34.4%), multifocal consolidations 17/61(27.9%). The advanced age and underlying diseases were significantly associated with abnormal chest CT. Conclusions: Abnormal chest CT is a common condition in Influenza-Like Illness cases. The presence of advanced age and concurrent underlying diseases is significantly associated with abnormal chest CT findings in patients with ILI symptoms. The chest CT characteristic of ILI is different from the manifestation of COVID-19 infection, which is helpful for differential diagnosis.


Subject(s)
COVID-19 , Diagnosis, Differential , Influenza, Human/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , China , Female , Humans , Image Interpretation, Computer-Assisted , Influenza, Human/physiopathology , Male , Middle Aged , Multivariate Analysis , Radiography, Thoracic , Retrospective Studies , SARS-CoV-2
10.
Int J Biol Sci ; 17(2): 539-548, 2021.
Article in English | MEDLINE | ID: covidwho-1090199

ABSTRACT

Rationale: Coronavirus disease 2019 (COVID-19) has caused a global pandemic. A classifier combining chest X-ray (CXR) with clinical features may serve as a rapid screening approach. Methods: The study included 512 patients with COVID-19 and 106 with influenza A/B pneumonia. A deep neural network (DNN) was applied, and deep features derived from CXR and clinical findings formed fused features for diagnosis prediction. Results: The clinical features of COVID-19 and influenza showed different patterns. Patients with COVID-19 experienced less fever, more diarrhea, and more salient hypercoagulability. Classifiers constructed using the clinical features or CXR had an area under the receiver operating curve (AUC) of 0.909 and 0.919, respectively. The diagnostic efficacy of the classifier combining the clinical features and CXR was dramatically improved and the AUC was 0.952 with 91.5% sensitivity and 81.2% specificity. Moreover, combined classifier was functional in both severe and non-serve COVID-19, with an AUC of 0.971 with 96.9% sensitivity in non-severe cases, which was on par with the computed tomography (CT)-based classifier, but had relatively inferior efficacy in severe cases compared to CT. In extension, we performed a reader study involving three experienced pulmonary physicians, artificial intelligence (AI) system demonstrated superiority in turn-around time and diagnostic accuracy compared with experienced pulmonary physicians. Conclusions: The classifier constructed using clinical and CXR features is efficient, economical, and radiation safe for distinguishing COVID-19 from influenza A/B pneumonia, serving as an ideal rapid screening tool during the COVID-19 pandemic.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnostic imaging , Influenza, Human/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic , Aged , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/virology , Deep Learning , Diagnosis, Differential , Humans , Influenza A virus/isolation & purification , Influenza B virus/isolation & purification , Influenza, Human/physiopathology , Influenza, Human/virology , Male , Middle Aged , Pandemics , Pneumonia , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , ROC Curve , Retrospective Studies , SARS-CoV-2/isolation & purification , Sensitivity and Specificity
11.
J Med Virol ; 93(5): 2947-2954, 2021 05.
Article in English | MEDLINE | ID: covidwho-1039177

ABSTRACT

The coronavirus 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world and is responsible for over 1,686,267 deaths worldwide. Co-infection with influenza A virus (IFV-A) during the upcoming flu season may complicate diagnosis and treatment of COVID-19. Little is known about epidemiology and outcomes of co-infection. Data for 213 COVID-19 patients treated at Tongji Hospital in Wuhan from January 28, 2020 to March 24, 2020 were retrospectively analyzed. Ninety-seven of the patients (45.5%) tested positive for anti- IFV-A immunoglobulin M antibodies. The clinical characteristics were described and analyzed for patients with SARS-CoV-2 infection only and patients with SARS-CoV-2/IFV-A co-infection. Patients with co-infection showed similar patterns of symptoms and clinical outcomes to patients with SARS-CoV-2 infection only. However, an increased expression of serum cytokines (interleukin-2R [IL-2R], IL-6, IL-8, and tumor necrosis factor-α) and cardiac troponin I, and higher incidence of lymphadenopathy were observed in patients with SARS-CoV-2 infection only. Male patients and patients aged less than 60 years in the SARS-CoV-2 infection group also had significantly higher computed tomography scores than patients in co-infection group, indicating that co-infection with IFV-A had no effect on the disease outcome but alleviated inflammation in certain populations of COVID-19 patients. The study will provide a reference for diagnosing and treating IFV-A and SARS-CoV-2 co-infection cases in the upcoming flu season.


Subject(s)
COVID-19/epidemiology , Coinfection/epidemiology , Influenza A virus , Influenza, Human/epidemiology , SARS-CoV-2 , Aged , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , China/epidemiology , Coinfection/complications , Coinfection/virology , Cytokines/blood , Female , Humans , Immunoglobulin M/blood , Influenza, Human/complications , Influenza, Human/diagnosis , Influenza, Human/physiopathology , Male , Middle Aged , Pandemics , Retrospective Studies , Seasons
12.
Int J Infect Dis ; 103: 316-322, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-959851

ABSTRACT

OBJECTIVES: Since the beginning of the severe acute respiratory syndrome coronavirus 2 pandemic, there is a discussion about the severity of coronavirus disease-2019 (COVID-19) in comparison to infections with seasonal Influenza. The objective of this study was to compare clinical and demographic characteristics of German patients hospitalized for infection with either SARS-CoV-2 or Influenza. METHODS: This study used anonymized German healthcare claims data. Patients with a confirmed COVID-19 or Influenza diagnosis, for whom a complete hospital course was available (i.e., the patient was discharged or died in hospital) were included. The data set included detailed information on patient characteristics and hospital treatment. Patients were grouped according to whether they were transferred to the intensive care unit (ICU), received mechanical ventilation (MV), or had a severe course of the disease (SD). Charlson Comorbidity Index in the eight quarters prior to hospitalization and secondary diagnoses during hospitalization were analyzed. RESULTS: A total of 2343 hospitalized patients with COVID-19 and 6762 hospitalized patients with Influenza were included. Fifty-four percent of the patients were male patients, with men being twice as frequent in the COVID-19 severe groups. For both diseases, patients >49 years accounted for almost three-quarters of hospital cases and hypertension, diabetes mellitus, chronic kidney disease, and chronic obstructive pulmonary disease were the most common comorbidities. The proportion of cases with ICU, MV, and SD was substantially higher for patients with COVID-19 (ICU+: 21 vs. 13 %; MV+: 15 vs. 9%; and SD+: 28 vs. 16%). Overall inhospital mortality was more than two-fold higher in COVID-19 vs. Influenza (14 vs. 6%).). The length of ventilation and hospitalization, and the proportion of patients diagnosed with acute respiratory distress syndrome, systemic inflammatory response syndrome, or acute kidney injury were considerably higher in patients with COVID-19. CONCLUSIONS: COVID-19 resulted in higher inhospital mortality and worse clinical outcomes than Influenza. This was not attributable to demographic characteristics, preexisting comorbidities, or patient triage, because the German healthcare system had not reached its limits in the pandemic. Discussions suggesting that COVID-19 and seasonal Influenza have similar severity cannot be based on clinical evidence.


Subject(s)
COVID-19/mortality , Influenza, Human/mortality , Adult , Aged , Aged, 80 and over , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Female , Germany , Hospital Mortality , Hospitalization , Humans , Influenza, Human/physiopathology , Influenza, Human/therapy , Male , Middle Aged , Pandemics , SARS-CoV-2 , Treatment Outcome
14.
J Dev Orig Health Dis ; 12(5): 683-687, 2021 10.
Article in English | MEDLINE | ID: covidwho-917501

ABSTRACT

The 1918 Influenza pandemic had long-term impacts on the cohort exposed in utero which experienced earlier adult mortality, and more diabetes, ischemic heart disease, and depression after age 50. It is possible that the Coronavirus Disease 2019 (COVID-19) pandemic will also have long-term impacts on the cohort that was in utero during the pandemic, from exposure to maternal infection and/or the stress of the pandemic environment. We discuss how COVID-19 disease during pregnancy may affect fetal and postnatal development with adverse impacts on health and aging. Severe maternal infections are associated with an exaggerated inflammatory response, thromboembolic events, and placental vascular malperfusion. We also discuss how in utero exposure to the stress of the pandemic, without maternal infection, may impact health and aging. Several recently initiated birth cohort studies are tracking neonatal health following in utero severe acute respiratory syndrome virus 2 (SARS-CoV-2) exposure. We suggest these cohort studies develop plans for longer-term observations of physical, behavioral, and cognitive functions that are markers for accelerated aging, as well as methods to disentangle the effects of maternal infection from stresses of the pandemic environment. In utero exposure to COVID-19 disease could cause developmental difficulties and accelerated aging in the century ahead. This brief review summarizes elements of the developmental origins of health, disease, and ageing and discusses how the COVID-19 pandemic might exacerbate such effects. We conclude with a call for research on the long-term consequences of in utero exposure to maternal infection with COVID-19 and stresses of the pandemic environment.


Subject(s)
Aging/physiology , COVID-19/physiopathology , Influenza, Human/physiopathology , Pregnancy Complications, Infectious/physiopathology , Prenatal Exposure Delayed Effects/physiopathology , Adult , Aged , COVID-19/transmission , COVID-19/virology , Child , Child Development/physiology , Child, Preschool , Female , History, 20th Century , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical/history , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza Pandemic, 1918-1919/history , Influenza Pandemic, 1918-1919/statistics & numerical data , Influenza, Human/history , Influenza, Human/virology , Middle Aged , Pandemics/history , Pandemics/statistics & numerical data , Pregnancy , Pregnancy Complications, Infectious/virology , Prenatal Exposure Delayed Effects/virology , SARS-CoV-2/pathogenicity
15.
Nat Rev Cardiol ; 18(3): 169-193, 2021 03.
Article in English | MEDLINE | ID: covidwho-851285

ABSTRACT

Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society.


Subject(s)
Cardiomyopathies/physiopathology , Inflammation/physiopathology , Myocarditis/physiopathology , Virus Diseases/physiopathology , Animals , Antiviral Agents/therapeutic use , Autoimmunity/immunology , Biopsy , COVID-19/physiopathology , COVID-19/therapy , Cardiomyopathies/diagnosis , Cardiomyopathies/immunology , Cardiomyopathies/therapy , Cardiomyopathy, Dilated , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Coxsackievirus Infections/immunology , Coxsackievirus Infections/physiopathology , Coxsackievirus Infections/therapy , Cytomegalovirus Infections/immunology , Cytomegalovirus Infections/physiopathology , Cytomegalovirus Infections/therapy , Disease Models, Animal , Echovirus Infections/immunology , Echovirus Infections/physiopathology , Echovirus Infections/therapy , Epstein-Barr Virus Infections/immunology , Epstein-Barr Virus Infections/physiopathology , Epstein-Barr Virus Infections/therapy , Erythema Infectiosum/immunology , Erythema Infectiosum/physiopathology , Erythema Infectiosum/therapy , HIV Infections/physiopathology , Hepatitis C/immunology , Hepatitis C/physiopathology , Hepatitis C/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Inflammation/diagnosis , Inflammation/immunology , Inflammation/therapy , Influenza, Human/immunology , Influenza, Human/physiopathology , Influenza, Human/therapy , Leukocytes/immunology , Myocarditis/diagnosis , Myocarditis/immunology , Myocarditis/therapy , Myocardium/pathology , Prognosis , Roseolovirus Infections/immunology , Roseolovirus Infections/physiopathology
16.
Rev Med Virol ; 31(3): e2179, 2021 05.
Article in English | MEDLINE | ID: covidwho-842504

ABSTRACT

We compared clinical symptoms, laboratory findings, radiographic signs and outcomes of COVID-19 and influenza to identify unique features. Depending on the heterogeneity test, we used either random or fixed-effect models to analyse the appropriateness of the pooled results. Overall, 540 articles included in this study; 75,164 cases of COVID-19 (157 studies), 113,818 influenza type A (251 studies) and 9266 influenza type B patients (47 studies) were included. Runny nose, dyspnoea, sore throat and rhinorrhoea were less frequent symptoms in COVID-19 cases (14%, 15%, 11.5% and 9.5%, respectively) in comparison to influenza type A (70%, 45.5%, 49% and 44.5%, respectively) and type B (74%, 33%, 38% and 49%, respectively). Most of the patients with COVID-19 had abnormal chest radiology (84%, p < 0.001) in comparison to influenza type A (57%, p < 0.001) and B (33%, p < 0.001). The incubation period in COVID-19 (6.4 days estimated) was longer than influenza type A (3.4 days). Likewise, the duration of hospitalization in COVID-19 patients (14 days) was longer than influenza type A (6.5 days) and influenza type B (6.7 days). Case fatality rate of hospitalized patients in COVID-19 (6.5%, p < 0.001), influenza type A (6%, p < 0.001) and influenza type B was 3%(p < 0.001). The results showed that COVID-19 and influenza had many differences in clinical manifestations and radiographic findings. Due to the lack of effective medication or vaccine for COVID-19, timely detection of this viral infection and distinguishing from influenza are very important.


Subject(s)
COVID-19/physiopathology , Influenza, Human/physiopathology , Respiratory Tract Infections/physiopathology , COVID-19/diagnostic imaging , COVID-19/epidemiology , COVID-19/mortality , Cough/diagnosis , Cough/physiopathology , Dyspnea/diagnosis , Dyspnea/physiopathology , Electronic Health Records , Fever/diagnosis , Fever/physiopathology , Humans , Infectious Disease Incubation Period , Influenza A virus/pathogenicity , Influenza A virus/physiology , Influenza B virus/pathogenicity , Influenza B virus/physiology , Influenza, Human/diagnostic imaging , Influenza, Human/epidemiology , Influenza, Human/mortality , Pharyngitis/diagnosis , Pharyngitis/physiopathology , Respiratory Tract Infections/diagnostic imaging , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/mortality , Rhinorrhea/diagnosis , Rhinorrhea/physiopathology , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology , Severity of Illness Index , Survival Analysis , Tomography, X-Ray Computed
17.
Can Respir J ; 2020: 1401053, 2020.
Article in English | MEDLINE | ID: covidwho-772148

ABSTRACT

Background: The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. Methods and Results: The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? Discussions. Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Conclusions: Because viral respiratory infections and TB impede the host's immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. The trial is registered with NCT04327206, NCT01829490, and NCT04121494.


Subject(s)
Coinfection/epidemiology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Tuberculosis/epidemiology , BCG Vaccine/therapeutic use , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coinfection/immunology , Coinfection/physiopathology , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Cytokines/immunology , Diagnostic Errors , Disease Outbreaks , Humans , Influenza, Human/epidemiology , Influenza, Human/physiopathology , Middle East Respiratory Syndrome Coronavirus , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , SARS Virus , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/physiopathology , Severity of Illness Index , Tuberculosis/immunology , Tuberculosis/physiopathology , Tuberculosis/prevention & control
18.
Stroke ; 51(10): 3156-3168, 2020 10.
Article in English | MEDLINE | ID: covidwho-748838

ABSTRACT

Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.


Subject(s)
Atherosclerosis/epidemiology , Infections/epidemiology , Stroke/epidemiology , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/physiopathology , Atherosclerosis/immunology , Atherosclerosis/physiopathology , Bacteremia/epidemiology , Bacteremia/immunology , Bacteremia/physiopathology , Betacoronavirus , COVID-19 , Chronic Disease , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Cytomegalovirus Infections/epidemiology , Cytomegalovirus Infections/immunology , Cytomegalovirus Infections/physiopathology , Endothelium/physiopathology , HIV Infections/epidemiology , HIV Infections/immunology , HIV Infections/physiopathology , Humans , Immunocompromised Host/immunology , Infections/immunology , Infections/physiopathology , Inflammation/immunology , Influenza, Human/epidemiology , Influenza, Human/immunology , Influenza, Human/physiopathology , Pandemics , Platelet Activation , Platelet Aggregation , Pneumonia/epidemiology , Pneumonia/immunology , Pneumonia/physiopathology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Prognosis , Risk Factors , SARS-CoV-2 , Stroke/immunology , Thrombosis/epidemiology , Thrombosis/immunology , Varicella Zoster Virus Infection/epidemiology , Varicella Zoster Virus Infection/immunology , Varicella Zoster Virus Infection/physiopathology
19.
Mol Cell Proteomics ; 19(11): 1749-1759, 2020 11.
Article in English | MEDLINE | ID: covidwho-713514

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a highly contagious infection and threating the human lives in the world. The elevation of cytokines in blood is crucial to induce cytokine storm and immunosuppression in the transition of severity in COVID-19 patients. However, the comprehensive changes of serum proteins in COVID-19 patients throughout the SARS-CoV-2 infection is unknown. In this work, we developed a high-density antibody microarray and performed an in-depth proteomics analysis of serum samples collected from early COVID-19 (n = 15) and influenza (n = 13) patients. We identified a large set of differentially expressed proteins (n = 132) that participate in a landscape of inflammation and immune signaling related to the SARS-CoV-2 infection. Furthermore, the significant correlations of neutrophil and lymphocyte with the CCL2 and CXCL10 mediated cytokine signaling pathways was identified. These information are valuable for the understanding of COVID-19 pathogenesis, identification of biomarkers and development of the optimal anti-inflammation therapy.


Subject(s)
Blood Proteins/immunology , Coronavirus Infections/immunology , Cough/immunology , Cytokine Release Syndrome/immunology , Fever/immunology , Headache/immunology , Influenza, Human/immunology , Myalgia/immunology , Pneumonia, Viral/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus/pathogenicity , Blood Proteins/genetics , COVID-19 , Child , Coronavirus Infections/genetics , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Cough/genetics , Cough/physiopathology , Cough/virology , Cytokine Release Syndrome/genetics , Cytokine Release Syndrome/physiopathology , Cytokine Release Syndrome/virology , Cytokines/genetics , Cytokines/immunology , Female , Fever/genetics , Fever/physiopathology , Fever/virology , Gene Expression Profiling , Gene Expression Regulation , Headache/genetics , Headache/physiopathology , Headache/virology , Humans , Influenza, Human/genetics , Influenza, Human/physiopathology , Influenza, Human/virology , Male , Middle Aged , Myalgia/genetics , Myalgia/physiopathology , Myalgia/virology , Orthomyxoviridae/pathogenicity , Pandemics , Pneumonia, Viral/genetics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Protein Array Analysis , Proteome/genetics , Proteome/immunology , Receptors, Cytokine/genetics , Receptors, Cytokine/immunology , SARS-CoV-2 , Signal Transduction/immunology
20.
Microbes Infect ; 22(9): 481-488, 2020 10.
Article in English | MEDLINE | ID: covidwho-599130

ABSTRACT

Clinical descriptions about influenza-like illnesses (ILI) in COVID-19 seem non-specific. We aimed to compare the clinical features of COVID-19 and influenza. We retrospectively investigated the clinical features and outcomes of confirmed cases of COVID-19 and influenza in Nord Franche-Comté Hospital between February 26th and March 14th 2020. We used SARS-CoV-2 RT-PCR and influenza virus A/B RT-PCR in respiratory samples to confirm the diagnosis. We included 124 patients. The mean age was 59 (±19 [19-98]) years with 69% female. 70 patients with COVID-19 and 54 patients with influenza A/B. Regarding age, sex and comorbidities, no differences were found between the two groups except a lower Charlson index in COVID-19 group (2 [±2.5] vs 3 [±2.4],p = 0.003). Anosmia (53% vs 17%,p < 0.001), dysgeusia (49% vs 20%,p = 0.001), diarrhea (40% vs 20%,p = 0.021), frontal headache (26% vs 9%,p = 0.021) and bilateral cracklings sounds (24% vs 9%,p = 0.034) were statistically more frequent in COVID-19. Sputum production (52% vs 29%,p = 0.010), dyspnea (59% vs 34%,p = 0.007), sore throat (44% vs 20%,p = 0.006), conjunctival hyperhemia (30% vs 4%,p < 0.001), tearing (24% vs 6%,p = 0.004), vomiting (22% vs 3%,p = 0.001) and rhonchi sounds (17% vs 1%,p = 0.002) were more frequent with influenza infection. We described several clinical differences which can help the clinicians during the co-circulation of influenza and SARS-CoV-2.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/diagnosis , Influenza A virus/pathogenicity , Influenza B virus/pathogenicity , Influenza, Human/diagnosis , Pneumonia, Viral/diagnosis , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Diagnosis, Differential , Diarrhea/diagnosis , Diarrhea/physiopathology , Diarrhea/virology , Dysgeusia/diagnosis , Dysgeusia/physiopathology , Dysgeusia/virology , Dyspnea/diagnosis , Dyspnea/physiopathology , Dyspnea/virology , Female , France , Headache/diagnosis , Headache/physiopathology , Headache/virology , Humans , Influenza, Human/physiopathology , Influenza, Human/virology , Male , Middle Aged , Olfaction Disorders/diagnosis , Olfaction Disorders/physiopathology , Olfaction Disorders/virology , Pandemics , Pharyngitis/diagnosis , Pharyngitis/physiopathology , Pharyngitis/virology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Vomiting/diagnosis , Vomiting/physiopathology , Vomiting/virology
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