Symptomatic Infection is Associated with Prolonged Duration of Viral Shedding in Mild Coronavirus Disease 2019: A Retrospective Study of 110 Children in Wuhan

Abstract Background Protection afforded from prior disease among patients with coronavirus disease 2019 (COVID-19) infection is unknown. If infection provides substantial long-lasting immunity, it may be appropriate to reconsider vaccination distribution. Methods This retrospective cohort study of 1 health system included 150 325 patients tested for COVID-19 infection via polymerase chain reaction from 12 March 2020 to 30 August 2020. Testing performed up to 24 February 2021 in these patients was included. The main outcome was reinfection, defined as infection ≥90 days after initial testing. Secondary outcomes were symptomatic infection and protection of prior infection against reinfection. Results Of 150 325 patients, 8845 (5.9%) tested positive and 141 480 (94.1%) tested negative before 30 August. A total of 1278 (14.4%) positive patients were retested after 90 days, and 62 had possible reinfection. Of those, 31 (50%) were symptomatic. Of those with initial negative testing, 5449 (3.9%) were subsequently positive and 3191 of those (58.5%) were symptomatic. Protection offered from prior infection was 81.8% (95% confidence interval [CI], 76.6–85.8) and against symptomatic infection was 84.5% (95% CI, 77.9–89.1). This protection increased over time. Conclusions Prior infection in patients with COVID-19 was highly protective against reinfection and symptomatic disease. This protection increased over time, suggesting that viral shedding or ongoing immune response may persist beyond 90 days and may not represent true reinfection. As vaccine supply is limited, patients with known history of COVID-19 could delay early vaccination to allow for the most vulnerable to access the vaccine and slow transmission.

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Dynamic changes in liver function parameters in patients with coronavirus disease 2019: a multicentre, retrospective study

BMC Infectious Diseases ◽

10.1186/s12879-021-06572-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qing-Lei Zeng ◽

Zu-Jiang Yu ◽

Fanpu Ji ◽

Guang-Ming Li ◽

Guo-Fan Zhang ◽

...

Keyword(s):

Retrospective Study ◽

Liver Disease ◽

Liver Function ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Gamma Glutamyl Transferase ◽

Dynamic Changes ◽

Viral Shedding ◽

Glutamyl Transferase ◽

Multicentre Retrospective Study

Abstract Background Liver injuries have been reported in patients with coronavirus disease 2019 (COVID-19). This study aimed to investigate the clinical role played by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods In this multicentre, retrospective study, the parameters of liver function tests in COVID-19 inpatients were compared between various time-points in reference to SARS-CoV-2 shedding, and 3 to 7 days before the first detection of viral shedding was regarded as the reference baseline. Results In total, 70 COVID-19 inpatients were enrolled. Twenty-two (31.4%) patients had a self-medication history after illness. At baseline, 10 (14.3%), 7 (10%), 9 (12.9%), 2 (2.9%), 15 (21.4%), and 4 (5.7%) patients already had abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, and total bilirubin (TBIL) values, respectively. ALT and AST abnormal rates and levels did not show any significant dynamic changes during the full period of viral shedding (all p > 0.05). The GGT abnormal rate (p = 0.008) and level (p = 0.033) significantly increased on day 10 of viral shedding. Meanwhile, no simultaneous significant increases in abnormal ALP rates and levels were observed. TBIL abnormal rates and levels significantly increased on days 1 and 5 of viral shedding (all p < 0.05). Albumin abnormal decrease rates increased, and levels decreased consistently from baseline to SARS-CoV-2 clearance day (all p < 0.05). Thirteen (18.6%) patients had chronic liver disease, two of whom died. The ALT and AST abnormal rates and levels did not increase in patients with chronic liver disease during SARS-CoV-2 shedding. Conclusions SARS-CoV-2 does not directly lead to elevations in ALT and AST but may result in elevations in GGT and TBIL; albumin decreased extraordinarily even when SARS-CoV-2 shedding ended.

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Lymphopenia predicted illness severity and recovery in patients with COVID-19: A single-center, retrospective study

PLoS ONE ◽

10.1371/journal.pone.0241659 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241659

Author(s):

Jiheng Liu ◽

Heng Li ◽

Ming Luo ◽

Jiyang Liu ◽

Lingzhen Wu ◽

...

Keyword(s):

Coronary Heart Disease ◽

Retrospective Study ◽

Clinical Laboratory ◽

Tertiary Hospital ◽

Outcome Data ◽

Single Center ◽

C Reactive Protein ◽

Reactive Protein ◽

Prolonged Duration ◽

Duration Of Hospitalization

The outbreak of SARS-CoV-2 began in December 2019 and rapidly became a pandemic. The present study investigated the significance of lymphopenia on disease severity. A total of 115 patients with confirmed COVID-19 from a tertiary hospital in Changsha, China, were enrolled. Clinical, laboratory, treatment and outcome data were gathered and compared between patients with and without lymphopenia. The median age was 42 years (1–75). Fifty-four patients (47.0%) of the 115 patients had lymphopenia on admission. More patients in the lymphopenia group had hypertension (30.8% vs. 10.0%, P = 0.006) and coronary heart disease (3.6% vs. 0%, P = 0.029) than in the nonlymphopenia group, and more patients with leukopenia (48.1% vs 14.8%, P<0.001) and eosinopenia (92.6% vs 54.1%, P<0.001) were observed. Lymphopenia was also correlated with severity grades of pneumonia (P<0.001) and C-reactive protein (CRP) level (P = 0.0014). Lymphopenia was associated with a prolonged duration of hospitalization (17.0 days vs. 14.0 days, P = 0.002). Lymphocyte recovery appeared the earliest, prior to CRP and chest radiographs, in severe cases, which suggests its predictive value for disease improvement. Our results demonstrated the clinical significance of lymphopenia for predicting the severity of and recovery from COVID-19, which emphasizes the need to dynamically monitor lymphocyte count.

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Influence of Fasting Plasma Glucose Level on Admission of COVID-19 Patients: A Retrospective Study

Journal of Diabetes Research ◽

10.1155/2022/7424748 ◽

2022 ◽

Vol 2022 ◽

pp. 1-8

Author(s):

Yingying Zhao ◽

Huichun Xing

Keyword(s):

Retrospective Study ◽

Blood Glucose ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Severe Disease ◽

Monitoring And Control ◽

Laboratory Findings ◽

Fasting Plasma ◽

Prolonged Duration ◽

The Relationship

Background. The coronavirus disease 2019 (COVID-19) is a serious global health threat and has spread dramatically worldwide. Prolonged viral shedding is associated with a more severe disease course and inflammatory reaction. Blood glucose levels were significantly associated with an increased hazard ratio (HR) for poor outcomes in COVID-19 patients. Objective. Previous studies focused primarily on the relationship between blood glucose and mortality or severe outcomes, but there were few research studies on the relationship between fasting plasma glucose (FPG) and duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positive status. To explore the relationship between FPG levels and prolonged duration of SARS-CoV-2 viral positivity, the clinical data of COVID-19 patients were analyzed. Method. In this retrospective study, 99 cases of COVID-19 patients in Beijing Ditan Hospital were recruited, and their clinical and laboratory findings at admission were collected and analyzed. Furthermore, the risk factors for prolonged duration of SARS-CoV-2 RNA shedding were identified, and the relationship between FPG levels and the prolonged presence of SARS-CoV-2 RNA was evaluated. Result. We found that elevated FPG levels were correlated with longer duration of SARS-CoV-2 RNA positivity, classification of COVID-19, imaging changes of chest CT, inflammation-related biomarkers, and CD8+ T cell number in COVID-19 patients. In a logistic regression model, after adjusting for gender and age, COVID-19 patients with elevated FPG were more likely to had longer duration of SARS-CoV-2 RNA positivity than those with normal FPG levels (OR 3.053 [95% CI 1.343, 6.936]). Conclusion. Higher FPG levels (≥6.1 mmol/l) at admission was an independent predictor for prolonged SARS-CoV-2 shedding, regardless of a known history of diabetes. It suggests that intensive monitoring and control of blood glucose are important for all COVID-19 patients.

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THE IMPACT OF ANTITUBERCULOSIS DRUG-INDUCED HEPATOTOXICITY TO SUCCESFUL TUBERCULOSIS TREATMENT IN INDONESIA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i11.20386 ◽

2017 ◽

Vol 10 (11) ◽

pp. 194 ◽

Cited By ~ 1

Author(s):

Nisa Maria ◽

Maksum Radji ◽

Erlina Burhan

Keyword(s):

Retrospective Study ◽

Tertiary Hospital ◽

Successful Outcome ◽

Antituberculosis Drug ◽

Duration Of Treatment ◽

Drug Induced ◽

Tb Treatment ◽

Prolonged Duration ◽

The Mean ◽

The Impact

Objective: This study aimed to evaluate the impact of antituberculosis (anti-TB) drug-induced hepatotoxicity (DIH) to outcome TB treatment.Methods: A cohort retrospective study conducted at a tertiary hospital in Jakarta - Indonesia, from the period of 2013-2016. A total of 76 samples of TB patient with and without anti-TB DIH were analyzed.Results: Successful outcome TB treatment for TB patient with anti-TB DIH is 47.4% compared to TB patient without anti-TB DIH is 78.9%. Relative risk (RR) analysis showed that risk of unsuccessful TB treatment for TB patient with anti-TB DIH is 2.50 fold higher (95% confidence interval: 1.259- 4.960) than TB patient without anti-TB DIH. Age, sex, and comorbidities are not statistically significant to outcome TB treatment. For TB patient with anti-TB DIH, onset anti-TB DIH and recurrence anti-TB DIH also not statistically significantly influence outcome TB. The mean duration of treatment for a successful outcome for TB patient with and without anti-TB DIH was statistically significant (p<0.05), respectively, 8.44±1.85 and 6.52±0.93 months.Conclusion: Anti-TB DIH increases the risk of unsuccessful and prolonged duration TB treatment.

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Variable Duration of Viral Shedding in Cancer Patients with COVID-19

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.378 ◽

2021 ◽

pp. 1-15

Author(s):

N. Esther Babady ◽

Bevin Cohen ◽

Tara McClure ◽

Karin Chow ◽

Mario Caldararo ◽

...

Keyword(s):

Public Health ◽

Retrospective Study ◽

Cancer Patients ◽

Solid Tumors ◽

Hematologic Malignancy ◽

Important Public Health ◽

Health Implications ◽

Cycle Threshold ◽

Viral Shedding ◽

Variable Duration

Abstract In this retrospective study of 105 SARS COV-2 infected cancer patients with longitudinal nasopharyngeal sampling, the duration of viral shedding and time to attain cycle threshold >30 was longer in patients with hematologic malignancy than those with solid tumors. These findings have important public health implications.

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Dynamic changes of liver function parameters in patients with coronavirus disease 2019: A multicenter, retrospective study

10.21203/rs.3.rs-48131/v1 ◽

2020 ◽

Author(s):

Qing-Lei Zeng ◽

Zu-Jiang Yu ◽

Fanpu Ji ◽

Guang-Ming Li ◽

Guo-Fan Zhang ◽

...

Keyword(s):

Retrospective Study ◽

Liver Function ◽

Liver Diseases ◽

Dynamic Change ◽

Chronic Liver ◽

Gamma Glutamyl Transferase ◽

Chronic Liver Diseases ◽

Clinical Role ◽

Viral Shedding ◽

Glutamyl Transferase

Abstract Background: Liver injuries in patients with coronavirus disease 2019 (COVID-19) have been reported, however, the clinical role played by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is obscure. Methods: In this multicenter, retrospective study, the parameters of liver function tests in COVID-19 inpatients were compared between various timepoints referred to SARS-CoV-2 shedding, and 3 to 7 days before first detection of viral shedding was regarded as reference baseline.Results: Totally, 70 COVID-19 inpatients were enrolled. Twenty-two (31.4%) cases had self-medications history after illness. At baseline, 10 (14.3%), 7 (10%), 9 (12.9%), 2 (2.9%), 15 (21.4%), and 4 (5.7%) patients already had abnormal rates of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, and total bilirubin (TBIL), respectively. ALT and AST abnormal rates and levels did not show any significantly dynamic change during the full period of viral shedding (all P > 0.05). GGT abnormal rate (P = 0.008) and level (P = 0.033) significantly increased on day 10 of viral shedding. Meanwhile, no simultaneously significant increases of ALP abnormal rates and levels were observed. TBIL abnormal rates and levels significantly increased on day 1 and 5 of viral shedding (all P < 0.05). Albumin abnormal decrease rates increased and levels decreased consistently from baseline to SARS-CoV-2 clearance day (all P < 0.05). Thirteen (18.6%) patients had chronic liver diseases, two of them died. The ALT and AST abnormal rates and levels did not increase in patients with chronic liver diseases during SARS-CoV-2 shedding.Conclusions: The SARS-CoV-2 does not directly lead to elevations of ALT and AST, but may result in elevations of GGT and TBIL, the albumin decreased extraordinarily even SARS-CoV-2 shedding discontinued.

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Low Morbidity but Prolonged Viral Shedding Characterize Parainfluenza Virus 3 Infections in Allogeneic Peripheral Stem Cell Transplant Recipients.

Blood ◽

10.1182/blood.v104.11.2234.2234 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2234-2234 ◽

Cited By ~ 1

Author(s):

Zakari Y. Aliyu ◽

Mary-Ann Bordner ◽

David K. Henderson ◽

Elaine M. Sloand ◽

Neal S. Young ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplant ◽

Conditioning Regimen ◽

Parainfluenza Virus ◽

Cell Transplant ◽

Viral Shedding ◽

Transplant Patients ◽

Prolonged Duration ◽

Absolute Lymphocyte Counts ◽

Human Parainfluenza Virus

Abstract Respiratory viruses including human parainfluenza virus 3 (hPIV3) may be significant causes of morbidity and mortality in patients undergoing allogeneic stem cell transplantation. It has been suggested that the acquisition of hPIV3 infections is independent of immunosuppression or transplant type and is driven primarily by patient exposure to the virus during periods of heightened community-wide or nosocomial activity. The incubation period for hPIV3 is 1–3 days and the duration of infectivity/ viral shedding in non-transplant patients is 1–2 weeks. Data regarding the duration of infectivity/ viral shedding and possible predictors of prolong infectivity in peripheral blood stem cell transplant patients (PBSCT) is limited. Of 56 recipients of sibling PBSCT seen at our insitution, 11 (6 inpatients and 5 outpatients) were positive for hPIV3 during a six weeks period, compared with only two positive cases recorded throughout the previous year. At the time of infection patients were between 1 and 7 weeks post transplant. The in-patient attack rate was 11%. Patients in whom respiratory virus infection was suspected were placed on respiratory isolation and followed with weekly nasopharygeal swab/wash (NPW). Care was also taken to limit patient contact of relatives or staff with respiratory symptoms. Most patients developed a flu like illness without major respiratory complications. No mortality was recorded. No case of hPIV 3 was recorded among patients with aplastic anemia receiving ATG in the unit during the same time-period. The median time to conversion from positive to negative hPIV 3 NPW was 2.0 weeks (range 1–6 weeks). The longest duration of viral shedding (six weeks) was in the only haplo-identical SCT patient, who was also the index case. No differences in duration of viral shedding was noted for conditioning regimen type (ablative vs non-ablative), days after transplant of viral acquisition (<15 or >15 days), cyclosporin levels (100–200 ng/l vs 201–400 ng/l), absolute neutrophil counts, absolute lymphocyte counts, CMV reactivation and co-existing peri-hPIV3 infections evidenced by positive blood, urine or sputum cultures. immunosuppression during the outbreak. Our study demonstrates that while hPIV infection in allogenic PBSCT patients has limited morbidity, prolonged duration of viral shedding in this group may contribute to recurrent cycles of epidemics or prolong outbreaks and establish an environmental (community/ nosocomial) contamination or “ping-pong” transmission from patients to asymptomatic health-care workers or family members and back. Our study also emphasize the importance of a universal policy for strict attention to infection-control practices and weekly surveillance NPW until patients are a symptomatic and NPW negative.

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Epidemiological characterization of symptomatic and asymptomatic COVID-19 cases and positivity in subsequent RT-PCR tests in the United Arab Emirates

PLoS ONE ◽

10.1371/journal.pone.0246903 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246903

Author(s):

Rami H. Al-Rifai ◽

Juan Acuna ◽

Farida Ismail Al Hossany ◽

Bashir Aden ◽

Shamma Abdullah Al Memari ◽

...

Keyword(s):

United Arab Emirates ◽

Abu Dhabi ◽

Confirmatory Test ◽

Prevention Measures ◽

Rt Pcr ◽

Public Places ◽

Viral Shedding ◽

Healthcare Settings ◽

Raising Awareness ◽

Prolonged Duration

The coronavirus disease 2019 (COVID-19) cases could be symptomatic or asymptomatic. We (1) characterized and analyzed data collected from the first cohort of reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases reported in the Emirate of Abu Dhabi, United Arab Emirates, according to the symptomatic state, and (2) identified factors associated with the symptomatic state. The association between the symptomatic state and testing positive in three subsequent RT-PCR testing rounds was also quantified. Between February 28 and April 8, 2020, 1,249 cases were reported. Sociodemographic characteristics, working status, travel history, and chronic comorbidities of 791 cases were analyzed according to the symptomatic state (symptomatic or asymptomatic). After the first confirmatory test, the results of three subsequent tests were analyzed. The mean age of the 791 cases was 35.6 ± 12.7 years (range: 1–81). Nearly 57.0% of cases were symptomatic. The two most frequent symptoms were fever (58.0%) and cough (41.0%). Symptomatic cases (mean age 36.3 ± 12.6 years) were significantly older than asymptomatic cases (mean age 34.5 ± 12.7 years). Compared with nonworking populations, working in public places (adjusted odds ratio (aOR), 1.76, 95% confidence interval (95% CI): 1.11–2.80), healthcare settings (aOR, 2.09, 95% CI: 1.01–4.31), or in the aviation and tourism sectors (aOR, 2.24, 95% CI: 1.14–4.40) was independently associated with the symptomatic state. Reporting at least one chronic comorbidity was also associated with symptomatic cases (aOR, 1.76, 95% CI: 1.03–3.01). Compared with asymptomatic cases, symptomatic cases had a prolonged duration of viral shedding and consistent odds of ≥2 positive COVID-19 tests result out of the three subsequent testing rounds. A substantial proportion of the diagnosed COVID-19 cases in the Emirate of Abu Dhabi were asymptomatic. Quarantining asymptomatic cases, implementing prevention measures, and raising awareness among populations working in high-risk settings are warranted.

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