scholarly journals Clinical Course and Risk Factors for Recurrence of Positive SARS-CoV-2 RNA: A Retrospective Cohort Study from Wuhan, China

2020 ◽  
Author(s):  
Jie Chen ◽  
Xiaoping Xu ◽  
Jing Hu ◽  
Qiangda Chen ◽  
Fengfeng Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Immune Regulation ◽  
Clinical Course ◽  
Ct Imaging ◽  
Imaging Features ◽  
Rt Pcr ◽  
Illness Onset ◽  
Preventative Measures ◽  
Lung Consolidation ◽  
Prolonged Observation

AbstractBackgroundCoronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has developed into a full-blown global pandemic. It has been reported that patients with COVID-19 meeting the criteria for hospital discharge (including two consecutive negative RT-PCR results) have experienced recurrent PCR positivity. However, the clinical course and risk factors for these patients have not been well described.MethodsIn this retrospective cohort study, consecutive patients with COVID-19 confirmed by RT-PCR from the Guanggu Branch of Hubei Province Maternity and Childcare Hospital from February 24, 2020 to March 31, 2020 were enrolled. All patients received follow-up to April 15, 2020 from discharge. The epidemiological, radiographic, laboratory, treatment, and outcome data were extracted from medical records. Univariate and multivariable logistic regression methods were used to elucidate risk factors for patients with recurrence of positive SARS-CoV-2 RNA.Results1087 COVID-19 patients were included in this study. Of these, 20 (1.8%) died and 1067 (98.2%) were discharged from the hospital. Among the discharged cases, there were 81 (7.6%) patients found to develop a repeat positive SARS-Cov-2 RNA result. Older age was obviously associated with death. For patients with recurrent RT-PCR positivity, the median duration from illness onset to onset of complete RNA negative was 33.0 days (range, 6.0-82.0 days; IQR, 20.0-41.0 days), while that from illness onset to recurrence was 50.0 days (range, 21.0-95.0 days; IQR, 36.5-59.5 days). Multivariate regression analysis identified recurrence of positive SARS-Cov-2 RNA was associated with elevated IL-6 levels (P=0.004, OR=3.050; 95% CI, 1.432-6.499), increased lymphocyte count (P=0.038, OR=2.321; 95% CI, 1.048-5.138) and CT imaging features of lung consolidation (P=0.038, OR=1.641; 95% CI, 1.028-2.620) during hospitalization.ConclusionElevated lymphocyte counts and IL-6 levels in blood, and consolidation features on CT imaging are useful risk factors for clinicians to identify patients at risk of developing recurrent positivity of SARS-CoV-2 RNA. This is speculated to be caused by a balance in immune regulation when fighting virus toxicity. For patients with a high risk of recurrent positivity, a prolonged observation and additional preventative measures should be implemented for at least 50 days after illness onset to prevent future outbreaks.Key PointsQuestionHow is the clinical course of patients with recurrence of positive SARS-CoV-2 RNA and what clinical characteristics are associated with that?FindingsIn this cohort involving 1067 COVID-19 patients discharged from the hospital, 81 (7.6%) patients found to develop a repeat positive SARS-Cov-2 RNA result. For patients with recurrent RT-PCR positivity, the median duration from illness onset to onset of complete RNA negative was 3.30 days (range, 6.0-82.0 days; IQR, 20.0-41.0 days), while that from illness onset to recurrence was 50.0 days (range, 21.0-95.0 days; IQR, 36.5-59.5 days). Risk factors associated with recurrence of positive SARS-Cov-2 RNA included elevated IL-6 levels, increased lymphocyte count and CT imaging features of lung consolidation during hospitalization.MeaningThe recurrence of positive SARS-Cov-2 RNA is speculated to be caused by a balance in immune regulation when fighting virus toxicity. For patients with a high risk of recurrent positivity, a prolonged observation and additional preventative measures should be implemented for at least 50 days after illness onset to prevent future outbreaks.

Clinical course and characteristics of patients with 2019 novel coronavirus disease in Wuhan, China: a single-centered, retrospective, observational study

2020 ◽  
Author(s):  
YANFANG LIU ◽  
LINA LIU ◽  
YE WANG ◽  
XINYANG DU ◽  
HONG MA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Diseases ◽  
Clinical Course ◽  
Rt Pcr ◽  
Laboratory Examination ◽  
Pcr Assay ◽  
Novel Coronavirus ◽  
Diagnosis Criteria ◽  
Supplement Therapy ◽  
Positive Results

Abstract BackgroundCOVID-19 associated with SARS-CoV-2 infection is of outbreak worldwide. This project aimed to provide clinical features, treatment advice and risk factors of patients diagnosed with COVID-19.MethodsIn this study, we analyzed 109 patients with confirmed COVID-19. We compared the relevant data of patients over 60 years old and under 60 years old, analyzed the data of patients with chronic diseases, and clarified the importance of the combination of laboratory examination and CT diagnosis.ResultsMost of patients 59(54.1%) had no fever. 100(91.7%) of patients required supplemental O2, and their SpO2 values reached normal after oxygen therapy. 72 (66.1%) patients were over 60 years old, and they were more likely to develop respiratory symptoms. Among all patients, only 14 (12.8%) patients were positive for anti-SARS-CoV-2 antibody, SARS-COV-2 RT-PCR assay and CT diagnosis.Conclusion(1) O2 supplement therapy plays an important role in the treatment of COVID-19 patients.(2) People over 60 years old or(and) having chronic diseases are risk factors of SARS-CoV-2 infection.(3) Most patients infected with SARS-CoV-2 have no fever symptoms.(4) We recommend that CT positive results be included in the confirmed diagnosis criteria, which is important for the diagnosis of COVID-19.

Cerebral Venous Thrombosis in Neonates, Children and Adolescents; Results from the German Pediatric Surveillance Unit for Rare Pediatric Diseases (ESPED)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 420-420
Author(s):  
Susanne Holzhauer ◽  
Christine Heller ◽  
Knöfler Ralf ◽  
Kentouche Karim ◽  
Krümpel Anne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Course ◽  
Ct Imaging ◽  
Small Sample ◽  
Individual Risk ◽  
Treatment Practices ◽  
Presenting Symptoms ◽  
Hereditary Thrombophilia ◽  
Surveillance Unit ◽  
The Impact

Abstract INTRODUCTION: Cerebral sinovenous thrombosis (CSVT) is a serious disease, that leads to longterm neurological sequaelae in the majority of survivors. There is uncertainty with regard to age specific individual risk factors, the impact of hereditary thrombophilia or underlying diseases on development of thrombosis or outcome. Previously published cohort studies have described epidemiology, treatment practices and outcomes, but those studies are limited due to small sample size or diversity of the populations included. Neonatal CSVT is seen as a disease entity different from cerebral thrombosis in older children with regard to etiology and outcome, evidence is lacking. OBJECTIVES: To evaluate the influence of transient risk factors and hereditary thrombophilia on clinical course, treatment practices and early outcome in a population based national cohort of children with CSVT. To study the influence of age (neonatal versus pediatric) on risk factors and outcome in CSVT. METHODS: We conducted a prospective nationwide surveillance study in pediatric patients <18 years through the hospital-based German Pediatric Surveillance Unit (ESPED). We included consecutive patients from 0-18 years of age admitted to hospitals in Germany with diagnosis of a first CSVT with an enrolment period between 2001-2010. Diagnosis was confirmed using MRI or CT imaging. Laboratory analysis of coagulation parameters have either been analyzed according to standardized thrombophilia screening protocols in the local hospitals or centrally in study center at the University of Muenster. We followed the course of disease over a period of 36 months. Follow up investigation included repetitive MRI or CT imaging and questionnaires on clinical outcome and recurrence. RESULTS: A total of 599 patients, from birth to 18 years with a diagnosis of CSVT were enrolled in the study. We have observed a male predominance with 61%. 138 (23%) CSVT cases were diagnosed during the neonatal period, 461 (77%) patients were older than one month at time of diagnosis. In our cohort 40% of neonates and 20% of older infants/children developed thrombosis without identified underlying predisposing diseases. The majority of transient triggers associated with the development of thrombosis were local (mastoiditis, 18%) or systemic (sepsis, meningitis, 13%) infections or asparaginase administration during treatment for leukemia or lymphoma (12%). Outcome, dependent both on age at onset and existence of transient triggers was worse in children with spontaneous CSVT compared to triggered CSVT with regard to mortality rate (11 vs. 3%), patency of the veins and neurological impairment. Moreover, presenting symptoms as well as the clinical course differed between neonates and older infants/children. CONCLUSION: In the pediatric population studied most of CSVT events were associated with infections as transient trigger. CSVT in neonates and children older than 1 months of age differed both with regard to underlying risk factors, treatment and outcome. Age specific, randomized controlled trials comparing treatment strategies are needed to optimize care in these patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.

2020 ◽  
Author(s):  
Dawei Wang ◽  
Yimei Yin ◽  
Chang Hu ◽  
Xing Liu ◽  
Xingguo Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Clinical Course ◽  
Case Series ◽  
Kidney Injury ◽  
Retrospective Case ◽  
Illness Onset ◽  
Independent Risk Factors ◽  
Systemic Symptoms ◽  
Novel Coronavirus

Abstract Background In December 2019, Coronavirus Disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical course and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. Methods Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan, and Xi-shui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic and clinical data were collected. Clinical course of survivors and non-survivors were compared. Risk factors for death were analyzed. Results A total of 107 discharged patients with COVID-19 were enrolled. The clinical course of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia and radiological multilobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury or adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome , refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia and death. Older age and male sex were independent risk factors for poor outcome of the illness. Conclusions A period of 7–13 days after illness onset is the critical stage in COVID-19 course. Age and male gender were independent risk factors for death of COVID-19.

scholarly journals Imaging features of evolving COVID-19 infection on computed tomography: Initial experience in Zhuhai, China.

2020 ◽  
Author(s):  
Yaqin Zhang ◽  
Pengfei Pang ◽  
Han Ma ◽  
Binghui Chen ◽  
Yingqin Li ◽  
...  
Keyword(s):  
Virus Disease ◽  
Disease Process ◽  
Imaging Features ◽  
Disease Course ◽  
Rt Pcr ◽  
Illness Onset ◽  
Radiological Features ◽  
History Of ◽  
Isolation Ward

Abstract Objectives To retrospectively analyze the most common imaging features on CT at baseline and as they evolve with time as the disease progresses or resolves in a cohort of patients affected with 2019 coronal virus disease (COVID-19) pneumonia in Zhuhai, China.Methods We evaluated 38 patients with COVID-19 in the authors’ institution from Jan 1 to Jan 31, 2020. Cases were confirmed by real-time RT-PCR and were analyzed for epidemiological, demographic, clinical, and radiological features. Outcomes were followed up until Feb 18, 2020. Results 38 initial scans and 62 follow-up scans were obtained. 28 (74%) patients had the history of travel to or residence in Hubei Province of China in 14 days prior to the illness onset. Common findings included ground-glass opacification (GGO), sometimes mixed with consolidation, and interlobular septal and intralobular interstitial thickening. Follow-up imaging often demonstrated peripheral GGO and consolidations spreading to the remainder of the lungs and the increasing consolidative component reflecting the progression of the disease. 8 patients (21%) whose swabs or serum were positive for COVID-19 had no imaging findings on CT throughout the disease course. After treatment the serum and sputum tests became negative for COVID-19 in 32(84%) cases. 28(74%) patients were discharged and three (8%) of them were transferred to the Observation Ward, while seven (18%) patients were kept in Isolation Ward. Conclusion The commonest pattern observed was GGO alone or GGO mixed with consolidation predominantly in lower and peripheral lungs. The follow-up CT scan is crucial for the diagnosis and evaluation of the disease process.

scholarly journals A false alarm of COVID-19 pneumonia in lung cancer with anti-PD-1 related pneumonitis: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ying Dai ◽  
Sha Liu ◽  
Yiruo Zhang ◽  
Xiaoqiu Li ◽  
Zhiyan Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Differential Diagnosis ◽  
Clinical Symptoms ◽  
Close Contact ◽  
Ct Imaging ◽  
Imaging Features ◽  
Rt Pcr ◽  
Lung Lobe ◽  
Clinical Presentations ◽  
Novel Coronavirus

Abstract Background Pneumonitis belongs to the fatal toxicities of anti-PD-1/PD-L1 treatments. Its diagnosis is based on immunotherapeutic histories, clinical symptoms, and the computed tomography (CT) imaging. The radiological features were typically ground-glass opacities, similar to CT presentation of 2019 Novel Coronavirus (COVID-19) pneumonia. Thus, clinicians are cautious in differential diagnosis especially in COVID-19 epidemic areas. Case presentation Herein, we report a 67-year-old Han Chinese male patient presenting with dyspnea and normal body temperature on the 15th day of close contact with his son, who returned from Wuhan. He was diagnosed as advanced non-small cell lung cancer and developed pneumonitis post Sintilimab injection during COIVD-19 pandemic period. The chest CT indicated peripherally subpleural lattice opacities at the inferior right lung lobe and bilateral thoracic effusion. The swab samples were taken twice within 72 hours and real-time reverse-transcription polymerase-chain-reaction (RT-PCR) results were COVID-19 negative. The patient was thereafter treated with prednisolone and antibiotics for over 2 weeks. The suspicious lesion has almost absorbed according to CT imaging, consistent with prominently falling CRP level. The anti-PD-1 related pneumonitis mixed with bacterial infection was clinically diagnosed based on the laboratory and radiological evidences and good response to the prednisolone and antibiotics. Conclusion The anti-PD-1 related pneumonitis and COVID-19 pneumonia possess similar clinical presentations and CT imaging features. Therefore, differential diagnosis depends on the epidemiological and immunotherapy histories, RT-PCR tests. The response to glucocorticoid is still controversial but helpful for the diagnosis.

scholarly journals Time correlation between serial RT-PCR results and serial chest CT imaging and serial CT changes of Coronavirus 2019 (COVID-19) Pneumonia: 155 cases study from China

2020 ◽  
Author(s):  
Jinfeng Gu ◽  
Li Yang ◽  
Tao Li ◽  
Ye Liu ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Time Correlation ◽  
Ct Imaging ◽  
Chest Ct ◽  
Imaging Features ◽  
Disease Course ◽  
Rt Pcr ◽  
Initial Symptoms ◽  
Serial Ct ◽  
Stage 1 ◽  
Pcr Test

Abstract Objective: To determine the CT role in the early detection of COVID-19 infection and serial CT changes in disease course in the patients with COVID-19 pneumonia. Methods: From January 21 to February 18, 2020, all the patients who were suspected of novel coronavirus infection and verified by RT-PCR test were retrospectively enrolled in our study. All the patients underwent serial RT-PCR tests and serial CT imaging. The time correlation between serial RT-PCR results (negative conversion to positive, positive to negative) and serial CT imaging was investigated, and serial CT changes were evaluated. Results: One hundred and fifty-five patients with confirmed COVID-19 pneumonia were evaluated. The time of chest CT detection of COVID-19 pneumonia was 2.61 days earlier than RT-PCR test (p=0.000). The time of lung CT improvement was significantly shorter than that of RT-PCR conversion to negative (p=0.000). Three stages were identified from the onset of the initial symptoms: Stage 1 (0-3 days); Stage 2 (4-7 days); and stage 3 (8-14 days and later). Ground glass opacity (GGO) was predominant on stage 1, then consolidation and crazy paving sign were dramatically increased on stage 2. On stage 3, fibrotic lesion was growing largely. There was significant difference for the main CT features (p=0.000), the number of involved lobes (p=0.001), and lesion distribution ( p=0.000) among different stages. Conclusion: Chest CT was earlier to detect COVID-19 pneumonia compared to RT-PCR results and monitor disease course. Combined imaging features with epidemiology history and clinical information could facilitate early diagnosis of COVID-19 pneumonia.

scholarly journals Coronavirus Disease 2019 (COVID-19) Candidate Chest CT Features: A Systematic Review of Extracted Imaging Features from 7571 Individuals

2020 ◽  
Author(s):  
Javad Zahiri ◽  
Mohammad Hossein Afsharinia ◽  
Zhaleh Hekmati ◽  
Mohsen Khodarahmi ◽  
Shahrzad Hekmati ◽  
...  
Keyword(s):  
False Negative ◽  
Ct Imaging ◽  
Response To Therapy ◽  
Imaging Features ◽  
Lung Involvement ◽  
Test Results ◽  
Rt Pcr ◽  
Pubmed Database ◽  
Bilateral Lung ◽  
Pcr Test

AbstractSince the outbreak of Coronavirus Disease 2019 (COVID-19) causing novel coronavirus (2019-nCoV)-infected pneumonia (NCIP), over 45 million affected cases have been reported worldwide. Many patients with COVID-19 have involvement of their respiratory system. According to studies in the radiology literature, chest computed tomography (CT) is recommended in suspected cases for initial detection, evaluating the disease progression and monitoring the response to therapy. The aim of this article is to review the most frequently reported imaging features in COVID-19 patients in order to provide a reliable insight into expected CT imaging manifestations in patients with positive reverse-transcription polymerase chain reaction (RT-PCR) test results, and also for the initial detection of patients with suspicious clinical presentation whose RT-PCR test results are false negative. A total of 60 out of 173 initial COVID-19 studies, comprising 7571 individuals, were identified by searching PubMed database for articles published between the months of January and June 2020. The data of these studies were related to patients from China, Japan, Italy, USA, Iran and Singapore. Among 40 reported features, presence of ground glass opacities (GGO), consolidation, bilateral lung involvement and peripheral distribution are the most frequently observed ones, reported in 100%, 91.7%, 85%, and 83.3% of articles, respectively. In a similar way, we extracted CT imaging studies of similar pulmonary syndromes outbreaks caused by other strains of coronavirus family: Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). For MERS and SARS, 2 out of 21 and 5 out of 153 initially retrieved studies had CT findings, respectively. Herein, we have indicated the most common coronavirus family related and COVID-19 specific features. Presence of GGO, consolidation, bilateral lung involvement and peripheral distribution were the features reported in at least 83% of COVID-19 articles, while air bronchogram, multi-lobe involvement and linear opacity were the three potential COVID-19 specific CT imaging findings. This is necessary to recognize the most promising imaging features for diagnosis and follow-up of patients with COVID-19. Furthermore, we identified co-existed CT imaging features.

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