RESUMO
The challenge of treating severely ill COVID-19 patients is particularly great due to the need to simultaneously manage oxygenation and the inflammatory state without compromising viral clearance. Currently, there are many tools to aid in oxygen management and in monitoring viral replication. However, predictive biomarkers for monitoring the host immune response across COVID-19 disease stages and specifically, for titrating immunomodulatory therapy are lacking. We utilized a recently cleared platform (MeMed Key) that enables rapid and easy serial measurement of IP-10, a host protein implicated in lung injury due to viral-induced hyperinflammation. A dynamic clinical decision support protocol was employed for managing SARS-CoV-2 positive patients admitted to a COVID-19 dedicated medical center run by Clalit Health Services. This is the first protocol to include real-time measurements of IP-10 as a potential aid for regulating inflammation. Overall, 502 serial real-time IP-10 measurements were performed on 52 patients recruited between 7th April 2020 to 10th May 2020, with 12 patients admitted to the intensive care unit (ICU). IP-10 levels correlated with increased COVID-19 severity score and ICU admission. Within the ICU admitted patients, the number of days with IP-10 measurements >1,000 pg/ml was associated with mortality. Upon administration of corticosteroid immunomodulatory therapy, a significant decrease in IP-10 levels was observed. Real-time IP-10 monitoring represents a new tool to aid in management and therapeutic decisions relating to the inflammatory status of COVID-19 patients.
RESUMO
BACKGROUND: Different types of adenoviruses are associated with diverse diseases and with varied disease severity. Adenovirus 55 could be associated with severe respiratory infections. OBJECTIVES: Here, we report on an adenovirus 55 outbreak in two psychiatric institutions in Israel. The objective of this study was to investigate the adenovirus 55 outbreak. STUDY DESIGN: We studied the clinical parameters of the patients and sequencing analysis of certain parts of the virus gene was performed. RESULTS: We identified the first patient who developed symptoms (the index case) and we showed that while both patients and staff members of the institutions were infected, the disease in the psychiatric patients was more severe. We attributed these differences to their mental and underlying health conditions. CONCLUSIONS: It is important to monitor for adenovirus infection in the community, especially in mental health institutions to allow appropriate medical care.
