ABSTRACT
Soon after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, preprocedural mouthwashes were recommended for temporarily reducing intraoral viral load and infectivity of individuals potentially infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to protect medical personnel. Particularly, the antiseptic cetylpyridinium chloride (CPC) has shown virucidal effects against SARS-CoV-2 in vitro. Therefore, the aim of this randomized controlled clinical trial was to investigate the efficacy of a commercially available mouthwash containing CPC and chlorhexidine digluconate (CHX) at 0.05% each in SARS-CoV-2-positive patients as compared to a placebo mouthwash. Sixty-one patients who tested positive for SARS-CoV-2 with onset of symptoms within the last 72 h were included in this study. Oropharyngeal specimens were taken at baseline, whereupon patients had to gargle mouth and throat with 20 mL test or placebo (0.9% NaCl) mouthwash for 60 s. After 30 min, further oropharyngeal specimens were collected. Viral load was analyzed by quantitative reverse transcriptase polymerase chain reaction, and infectivity of oropharyngeal specimens was analyzed by virus rescue in cell culture and quantified via determination of tissue culture infectious doses 50% (TCID50). Data were analyzed nonparametrically (α = 0.05). Viral load slightly but significantly decreased upon gargling in the test group (P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID50 also significantly decreased in the test group (P = 0.0313), whereas there was no significant effect but a trend in the placebo group. Furthermore, it was found that the specimens from patients with a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without vaccine booster (P = 0.0231). This study indicates that a preprocedural mouthwash containing CPC and CHX could slightly but significantly reduce the viral load and infectivity in SARS-CoV-2-positive patients. Further studies are needed to corroborate these results and investigate whether the observed reductions in viral load and infectivity could translate into clinically useful effects in reducing COVID-19 transmission (German Clinical Trials Register DRKS00027812).
Subject(s)
COVID-19 , Mouthwashes , Humans , Mouthwashes/pharmacology , Mouthwashes/therapeutic use , SARS-CoV-2 , Mouth , Pandemics/prevention & controlABSTRACT
BACKGROUND AND OBJECTIVE: Borreliosis may be associated with unspecific symptoms and thus not only cause difficulties in diagnosis but also lead to overdiagnosis. PATIENTS AND METHODS: Data on 134 patients (mean age 47 [12â-â78] years, 51.5â% male) with suspected borreliosis presenting at the university hospital Regensburg were analyzed retrospectively. RESULTS: The majority of patients had been adequately treated for borreliosis previously. 34 patients (25.4â%) had proven or possible borreliosis, 20 patients (14.9â%) presented for consultation only. Regarding the remaining 80 patients (59.7â%), in 36 (45â%) a rheumatologic, orthopedic or neurologic disease was found as causal for the presenting symptoms, in 44 (55â%) no somatic disease could be diagnosed. CONCLUSION: A careful differential diagnosis seems mandatory in patients with suspected borreliosis and persistent complaints.
Subject(s)
Borrelia burgdorferi , Lyme Disease/diagnosis , Adolescent , Adult , Aged , Animals , Anti-Bacterial Agents/therapeutic use , Bites and Stings/complications , Central Nervous System Diseases/diagnosis , Child , Chronic Disease , Diagnosis, Differential , Female , Glossitis, Benign Migratory/diagnosis , Hospitals, University , Humans , Lyme Disease/drug therapy , Lyme Neuroborreliosis/diagnosis , Male , Middle Aged , Musculoskeletal Diseases/diagnosis , Retrospective Studies , Rheumatic Diseases/diagnosis , Syndrome , Ticks , Young AdultABSTRACT
Guidelines, clinical pathways and clinical algorithms are popular instruments nowadays to ensure quality as well as the economic efficiency of medical work. These terms themselves, however, are frequently defined only in a diffuse way. Thus, medical standard procedures often complicate clinical workflows more than to facilitate decision making in everyday life. In our department, feasible standardized approaches have been generated in the form of structured text documents, which on the one hand can aid clinical decision making at the bedside and on the other hand serve as medical sketches for the generation of operational treatment paths on an interdisciplinary level. Structure and content of such an instructional text are exemplified here using our standardized document for the diagnostic approach when tuberculosis is suspected.
