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1.
BMC Infect Dis ; 20(1): 429, 2020 Jun 19.
Article in English | MEDLINE | ID: covidwho-608211

ABSTRACT

BACKGROUND: Since December 2019, over 80,000 patients with coronavirus disease 2019 (COVID-19) have been confirmed in China. With the increasing number of recovered patients, more attention should be paid to the follow-up of these patients. METHODS: In the study, 576 patients with COVID-19 discharged from hospital in Chongqing, China from January 24, 2020, to March 10, 2020 were evaluated by viral nucleic acid tests for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) to determine if they could be released from quarantine. Among the 576 patients, 61 patients (10.6%) had positive RT-PCR test results of SARS-CoV-2. We aimed to analyze the demographics, clinical characteristics and treatment of 61 patients. RESULTS: These positive patients were characterized by older age, chronic medical illness and mild conditions. 38 (62.3%) patients who were asymptomatic without abnormalities on chest radiographs were found in the positive with COVID-19. Also, they showed positive results of stool or sputum specimens with negative results of nasal and pharyngeal swab specimens. The median duration of positive result of SARS-CoV-2 was varied from 3 days to 35 days in the patients discharged from hospital with no family member infection. CONCLUSIONS: Multi-site screening of SARS-CoV-2 including nasal and pharyngeal swabs, stool and sputum specimens could be considered to improve the diagnosis, treatment and infection control in patients with COVID-19. Our findings provide the important information and clinical evidence for the improved management of patients recovered from COVID-19.


Subject(s)
Coronavirus Infections/diagnosis , Patient Discharge , Pneumonia, Viral/diagnosis , Adult , Aged , Betacoronavirus , China , Clinical Laboratory Techniques , Feces/virology , Female , Humans , Male , Middle Aged , Nose/virology , Pandemics , Pharynx/virology , RNA, Viral/isolation & purification , Sputum/virology
5.
Cell Host Microbe ; 28(1): 124-133.e4, 2020 07 08.
Article in English | MEDLINE | ID: covidwho-378130

ABSTRACT

Since December 2019, a novel coronavirus SARS-CoV-2 has emerged and rapidly spread throughout the world, resulting in a global public health emergency. The lack of vaccine and antivirals has brought an urgent need for an animal model. Human angiotensin-converting enzyme II (ACE2) has been identified as a functional receptor for SARS-CoV-2. In this study, we generated a mouse model expressing human ACE2 (hACE2) by using CRISPR/Cas9 knockin technology. In comparison with wild-type C57BL/6 mice, both young and aged hACE2 mice sustained high viral loads in lung, trachea, and brain upon intranasal infection. Although fatalities were not observed, interstitial pneumonia and elevated cytokines were seen in SARS-CoV-2 infected-aged hACE2 mice. Interestingly, intragastric inoculation of SARS-CoV-2 was seen to cause productive infection and lead to pulmonary pathological changes in hACE2 mice. Overall, this animal model described here provides a useful tool for studying SARS-CoV-2 transmission and pathogenesis and evaluating COVID-19 vaccines and therapeutics.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections , Disease Models, Animal , Mice, Inbred C57BL , Pandemics , Pneumonia, Viral , Aging , Animals , Brain/virology , CRISPR-Cas Systems , Coronavirus Infections/pathology , Coronavirus Infections/virology , Cytokines/blood , Gene Knock-In Techniques , Lung/pathology , Lung/virology , Lung Diseases, Interstitial/pathology , Nose/virology , Peptidyl-Dipeptidase A/genetics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , RNA, Viral/analysis , Stomach/virology , Trachea/virology , Viral Load , Virus Replication
6.
Otolaryngol Head Neck Surg ; 163(3): 465-470, 2020 09.
Article in English | MEDLINE | ID: covidwho-378052

ABSTRACT

OBJECTIVE: In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies. STUDY DESIGN: Prospective quantification of airborne aerosol generation during surgical and clinical simulation. SETTING: Cadaver laboratory and clinical examination room. SUBJECTS AND METHODS: Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation. RESULTS: Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 µm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (P < .001). In clinical simulations, nasal endoscopy (P < .05), speech (P < .01), and sneezing (P < .01) generated 1- to 10-µm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask (P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread. CONCLUSION: Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 µm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.


Subject(s)
Aerosols/adverse effects , Coronavirus Infections/transmission , Nose/virology , Otorhinolaryngologic Surgical Procedures , Pneumonia, Viral/transmission , Betacoronavirus , Cadaver , Endoscopy , Humans , Pandemics , Particle Size , Personal Protective Equipment , Prospective Studies , Risk Factors
7.
J Stroke Cerebrovasc Dis ; 29(9): 104981, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-342995

ABSTRACT

Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this scenario, managing acute medical conditions, such as stroke, requires a timely treatment together with proper strategies that minimize the risk of infection spreading to health care workers and other patients. We report the case of a 79-year-old woman, who was admitted for a wake-up stroke due to occlusion of the left middle cerebral artery. She was treated outside the COVID-19-dedicated track of the hospital because she had no concomitant signs or symptoms suggestive of SARS-CoV-2 infection nor recent contact with other infected individuals. Post-mortem nasal and pharyngeal swab was positive for SARS-CoV-2 infection. We propose that hyperacute stroke patients should be tested for SARS-CoV-2 infection at admission and then managed as having COVID-19 until cleared by a negative result. We are aware that such measure results in some delay of the acute treatment of stroke, which could be minimal using well-exercised containment protocols.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Infarction, Middle Cerebral Artery/therapy , Nose/virology , Pharynx/virology , Pneumonia, Viral/diagnosis , Aged , Coronavirus Infections/transmission , Coronavirus Infections/virology , Delayed Diagnosis , Fatal Outcome , Female , Humans , Infarction, Middle Cerebral Artery/diagnosis , Infarction, Middle Cerebral Artery/physiopathology , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Exposure/adverse effects , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Predictive Value of Tests , Risk Factors , Severity of Illness Index
9.
Int J Pediatr Otorhinolaryngol ; 135: 110092, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-197689

ABSTRACT

While children, particularly infants, are susceptible to severe and critical COVID-19 disease, over 55% of pediatric cases are present in asymptomatic or mildly symptomatic children. Aerosolized SARS-CoV-2 viral particles remain viable for up to 3 hours, raising concern about risk to healthcare workers during aerosol generating procedures (APGs) in the airway and nasopharynx. Herein we describe the first case of a nasal foreign body in an asymptomatic child with SARS-CoV-2 infection. We discuss management of this child and highlight the importance of considering asymptomatic infection and preoperative testing when planning procedures of the airway in the COVID-19 era.


Subject(s)
Asymptomatic Infections , Betacoronavirus/isolation & purification , Coronavirus Infections , Endoscopy/methods , Foreign Bodies/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Nose/virology , Pandemics , Pneumonia, Viral , Betacoronavirus/genetics , Child, Preschool , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Female , Humans , Nose/surgery , Pneumonia, Viral/diagnosis , Preoperative Care , Reverse Transcriptase Polymerase Chain Reaction
10.
J Clin Virol ; 128: 104417, 2020 07.
Article in English | MEDLINE | ID: covidwho-165280

ABSTRACT

OBJECTIVES: To evaluate the reliability of self-collection for SARS-CoV-2 and other respiratory viruses because swab collections for SARS-CoV-2 put health workers at risk of infection and require use of personal protective equipment (PPE). METHODS: In a prospective study, patients from two states in Australia attending dedicated COVID-19 collection clinics were offered the option to first self-collect (SC) nasal and throat swabs (SCNT) prior to health worker collect (HC) using throat and nasal swabs (Site 1) or throat and nasopharyngeal swabs (Site 2). Samples were analysed for SARS-CoV-2 as well as common respiratory viruses. Concordance of results between methods was assessed using Cohen's kappa (κ) and Cycle threshold (Ct) values were recorded for all positive results as a surrogate measure for viral load. RESULTS: Of 236 patients sampled by HC and SC, 25 had SARS-CoV-2 (24 by HC and 25 by SC) and 63 had other respiratory viruses (56 by HC and 58 by SC). SC was highly concordant with HC (κ = 0.890) for all viruses including SARS-CoV-2 and more concordant than HC to positive results by any method (κ = 0.959 vs 0.933). Mean SARS-CoV-2 E-gene and N-gene, rhinovirus and parainfluenza Ct values did not differ between HC and SCNT. CONCLUSIONS: Self-collection of nasal and throat swabs offers a reliable alternative to health worker collection for the diagnosis of SARS-CoV-2 and other respiratory viruses and provides patients with easier access to testing, reduces exposure of the community and health workers to those being tested and reduces requirement for PPE.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , Specimen Handling/methods , Adolescent , Adult , Aged , Aged, 80 and over , Australia , Child , Coronavirus Infections/virology , Female , Humans , Male , Middle Aged , Nasopharynx/virology , Nose/virology , Pharynx/virology , Pneumonia, Viral/virology , Prospective Studies , Reproducibility of Results , Viral Load , Young Adult
11.
Lab Chip ; 20(9): 1621-1627, 2020 05 05.
Article in English | MEDLINE | ID: covidwho-116332

ABSTRACT

Rapid, sensitive and specific detection and reporting of infectious pathogens is important for patient management and epidemic surveillance. We demonstrated a point-of-care system integrated with a smartphone for detecting live virus from nasal swab media, using a panel of equine respiratory infectious diseases as a model system for corresponding human diseases such as COVID-19. Specific nucleic acid sequences of five pathogens were amplified by loop-mediated isothermal amplification on a microfluidic chip and detected at the end of reactions by the smartphone. Pathogen-spiked horse nasal swab samples were correctly diagnosed using our system, with a limit of detection comparable to that of the traditional lab-based test, polymerase chain reaction, with results achieved in ∼30 minutes.


Subject(s)
Horse Diseases/diagnosis , Lab-On-A-Chip Devices , Molecular Diagnostic Techniques/methods , Nucleic Acid Amplification Techniques/methods , Respiration Disorders/veterinary , Smartphone , Animals , Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Herpesvirus 1, Equid/isolation & purification , Herpesvirus 4, Equid/isolation & purification , Horse Diseases/microbiology , Horse Diseases/virology , Horses , Influenza A Virus, H3N8 Subtype/isolation & purification , Mobile Applications , Nose/microbiology , Nose/virology , Point-of-Care Systems , Respiration Disorders/diagnosis , Respiration Disorders/microbiology , Respiration Disorders/virology , Streptococcus equi/isolation & purification
12.
J Clin Virol ; 127: 104346, 2020 06.
Article in English | MEDLINE | ID: covidwho-46206

ABSTRACT

BACKGROUND: With the spread of Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, its effect on society is amplified. We aimed to describe the viral detection results across different timepoints throughout the disease course. METHODS: A retrospective study of 301 confirmed COVID-19 patients hospitalized at Tongji Hospital in Wuhan, China, were included. Demographic characteristics of the patients were collected. Upper respiratory specimens (throat and/or nasal swabs) were obtained and analyzed by real-time RT-PCR for SARS-CoV-2 infection. Period of viral infection and the contagious stage were analyzed. RESULTS: Of 301 hospitalized COVID-19 patients, the median age was 58 years and 51.2 % were male. The median period between symptoms presence and positive SARS-CoV-2 RT-PCR results was 16 days (IQR, 10-23, N = 301). The median period between symptoms presence and an effective negative SARS-CoV-2 RT-PCR result was 20 days (IQR, 17-24; N = 216). Infected patient ≥65 years old stayed contagious longer (22 days vs 19 days, p = 0.015). Although two consecutive negative results were confirmed in 70 patients, 30 % of them had positive viral test results for the third time. Using specimens from nasal swabs to run the RT-PCR test showed a higher positive rate than using specimens from throat swabs. CONCLUSIONS: This large-scale investigation with 1113 RT-PCR test results from 301 COVID-19 patients showed that the average contagious period of SARS-CoV-2 infected patients was 20 days. Longer observation period and more than 2 series of negative viral test are necessary for patients ≥65 years.


Subject(s)
Coronavirus Infections/diagnosis , Nose/virology , Pharynx/virology , Pneumonia, Viral/diagnosis , Reverse Transcriptase Polymerase Chain Reaction , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Child , China/epidemiology , Clinical Laboratory Techniques , False Negative Reactions , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Qualitative Research , Respiratory System/virology , Retrospective Studies , Sex Factors , Young Adult
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