scholarly journals Association between incubation period and clinical characteristics of patients with COVID-19

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095683
Author(s):  
Yeyu Cai ◽  
Jiayi Liu ◽  
Haitao Yang ◽  
Mian Wang ◽  
Qingping Guo ◽  
...  
Keyword(s):  
Incubation Period ◽  
Disease Severity ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Receiver Operator Characteristic Curve ◽  
Hunan Province ◽  
Laboratory Findings ◽  
Incubation Periods

Purpose To investigate associations between the clinical characteristics and incubation periods of patients infected with coronavirus disease 2019 (COVID-19) in Wuhan, China. Methods Complete clinical and epidemiological data from 149 patients with COVID-19 at a hospital in Hunan Province, China, were collected and retrospectively analyzed. Results Analysis of the distribution and receiver operator characteristic curve of incubation periods showed that 7 days was the optimal cut-off value to assess differences in disease severity between groups. Patients with shorter (≤7 days) incubation periods (n = 79) had more severe disease, longer durations of hospitalization, longer times from symptom onset to discharge, more abnormal laboratory findings, and more severe radiological findings than patients with longer (>7 days) incubation periods. Regression and correlation analyses also showed that a shorter incubation period was associated with longer times from symptom onset to discharge. Conclusion The associations between the incubation periods and clinical characteristics of COVID-19 patients suggest that the incubation period may be a useful marker of disease severity and prognosis.

Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF)

2016 ◽  
Vol 75 (6) ◽  
pp. 1051-1056 ◽  
Author(s):  
Erkan Demirkaya ◽  
Cengizhan Acikel ◽  
Philip Hashkes ◽  
Marco Gattorno ◽  
Ahmet Gul ◽  
...  
Keyword(s):  
Familial Mediterranean Fever ◽  
Disease Severity ◽  
Severity Score ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Future Research ◽  
Laboratory Findings ◽  
Therapeutic Decisions ◽  
Mediterranean Fever

ObjectiveTo develop widely accepted international severity score for children and adult patients with familial Mediterranean fever (FMF) that can be easily applied, in research and clinical practice.MethodsCandidate severity criteria were suggested by several FMF expert physicians. After three rounds of Delphi survey, the candidate criteria, defined by the survey, were discussed by experts in a consensus meeting. Each expert brought data of clinical manifestations, laboratory findings and physician's global assessments (PGAs) of minimum 20 patients from their centres. We used the PGAs for disease severity as a gold standard. Logistic regression analysis was used to evaluate the predicting value of each item, and receiver operating characteristic curve analysis was performed to demonstrate the success of the criteria set.ResultsA total of 281 patients consist of 162 children and 119 adults with FMF were enrolled and available for validity analysis: Nine domains were included in the final core set of variables for the evaluation of disease severity in FMF. The International Severity Score for FMF (ISSF) may reach a maximum of 10 if all items are maximally scored. The threshold values to determine: severe disease ≥6, intermediate disease 3–5, mild disease ≤2. Area under the curve was calculated as 0.825 for this set in the whole group.ConclusionsThe initial validity of ISSF both in children and adult with FMF was demonstrated. We anticipate that it will provide a robust tool to objectively define disease severity for clinical trials, future research as well as for therapeutic decisions in managing patients with FMF.

scholarly journals Transmission and clinical characteristics of coronavirus disease 2019 in 104 outside-Wuhan patients, China

2020 ◽  
Author(s):  
Chengfeng Qiu ◽  
Qian Xiao ◽  
Xin Liao ◽  
Ziwei Deng ◽  
Huiwen Liu ◽  
...  
Keyword(s):  
Incubation Period ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Antiviral Treatment ◽  
Hunan Province ◽  
Main Body ◽  
Medication Therapy ◽  
Traditional Chinese Medicine Therapy ◽  
Contact Investigation ◽  
Imported Cases

AbstractBackgroundCases with coronavirus disease 2019 (COVID-19) emigrated from Wuhan escalated the risk of spreading in other cities. This report focused on the outside-Wuhan patients to assess the transmission and clinical characteristics of this illness.MethodsContact investigation was conducted on each patient who admitted to the assigned hospitals in Hunan Province (geographically adjacent to Wuhan) from Jan 22, 2020 to Feb 12, 2020. Demographic, clinical, laboratory and radiological characteristics, medication therapy and outcomes were collected and analyzed. Patients were confirmed by PCR test.ResultsOf the 104 patients, 48 (46.15%) were imported cases and 56 (53.85%) were indigenous cases; 93 (89.42%) had a definite contact history with infections. Family clusters were the major body of patients. Transmission along the chain of 3 “generations” was observed. Mean age was 43 (rang, 8-84) years (including 3 children) and 49 (47.12%) were male. Most patients had typical symptoms, 5 asymptomatic infections were found and 2 of them infected their relatives. The median incubation period was 6 (rang, 1-32) days, of 8 patients ranged from 18 to 32 days. Just 9 of 16 severe patients required ICU care. Until Feb 12, 2020, 40 (38.46%) discharged and 1 (0.96%) died. For the antiviral treatment, 80 (76.92%) patients received traditional Chinese medicine therapy.ConclusionsFamily but not community transmission occupied the main body of infections in the two centers. Asymptomatic transmission demonstrated here warned us that it may bring more risk to the spread of COVID-19. The incubation period of 8 patients exceeded 14 days.

scholarly journals Changes in liver function in patients with covid-19 and the demographics of the disease in a mid-sized city of Turkey: A retrospective analysis

2020 ◽  
Vol 7 (12) ◽  
pp. 739-744
Author(s):  
Huseyin Avni Demir
Keyword(s):  
Liver Function ◽  
Clinical Characteristics ◽  
Severe Disease ◽  
Close Monitoring ◽  
Test Results ◽  
Laboratory Findings ◽  
Icu Patients ◽  
Mortality And Morbidity ◽  
The Mean ◽  
Significant Mortality

Objective:  To define the clinical characteristics of patients hospitalized with COVID-19 in ICU and ward and to evaluate the significance of liver function test results. A new disease caused by SARS-CoV-2 has been devastating the world affecting millions of patients worldwide and leading the significant mortality and morbidity. Material and Methods: The demographic features of a cohort of 125 hospitalized patients between March 2020 and May 2020 were recorded. The clinical characteristics, laboratory findings, and mortality rates were analyzed. Results: A total of 125 patients hospitalized for COVID-19 diagnosis where 113 (90.4%) were followed-up in the ward and 12 (9.6%) were in ICU were included in the study. The mean age of the patients was 44.05±16.95 and 88 (70.4%) of the patients were male. The most common symptoms were in the following order: cough in 80 patients (64%), dyspnea in 40 (32%) and fever in 33 (26.4%). The leukocyte and neutrophil counts were significantly higher in ICU patients with COVID-19 compared to patients in the ward (p=0.002, p<0.05; respectively). The CRP and D-Dimer levels were found elevated in ICU patients with COVID-19 than in the ward (p<0.05; p<0.05, respectively). The AST level of patients with COVID-19 in ICU was significantly heightened than patients in the ward. Conclusion: The present study revealed that patients with elevated AST level were at great risk of progressing to severe disease those require close monitoring.

scholarly journals Epidemiological parameters of coronavirus disease 2019: a pooled analysis of publicly reported individual data of 1155 cases from seven countries

2020 ◽  
Author(s):  
Shujuan Ma ◽  
Jiayue Zhang ◽  
Minyan Zeng ◽  
Qingping Yun ◽  
Wei Guo ◽  
...  
Keyword(s):  
Latent Period ◽  
Incubation Period ◽  
Symptom Onset ◽  
Severe Disease ◽  
Individual Data ◽  
Robust Estimates ◽  
Upper Limit ◽  
Serial Interval ◽  
Epidemiological Parameters ◽  
Time Point

SummaryBackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has been declared a pandemic by the World Health Organization, while several key epidemiological parameters of the disease remain to be clarified. This study aimed to obtain robust estimates of the incubation period, upper limit of latent period (interval between infector’s exposure and infectee’s exposure), serial interval, time point of exposure (the day of infectee’s exposure to infector relative to the latter’s symptom onset date) and basic reproduction number (R0) of COVID-19.MethodsBetween late February and early March of 2020, the individual data of laboratory confirmed cases of COVID-19 were retrieved from 10728 publicly available reports released by the health authorities of and outside China and from 1790 publications identified in PubMed and CNKI. To be eligible, a report had to contain the data that allowed for estimation of at least one parameter. As relevant data mainly came from clustering cases, the clusters for which no evidence was available to establish transmission order were all excluded to ensure accuracy of estimates. Additionally, only the cases with an exposure period spanning 3 days or less were included in the estimation of parameters involving exposure date, and a simple method for determining exposure date was adopted to ensure the error of estimates be small (< 0.3 day). Depending on specific parameters, three or four of normal, lognormal, Weibull, and gamma distributions were fitted to the datasets and the results from appropriate models were presented.FindingsIn total, 1155 cases from China, Japan, Singapore, South Korea, Vietnam, Germany and Malaysia were included for the final analysis. The mean and standard deviation were 7.44 days and 4.39 days for incubation period, 2.52 days and 3.95 days for the upper limit of latent period, 6.70 days and 5.20 days for serial interval, and −0.19 day (i.e., 0.19 day before infector’s symptom onset) and 3.32 days for time point of exposure. R0 was estimated to be 1.70 and 1.78 based on two different formulas. For 39 (6.64%) cases, the incubation periods were longer than 14 days. In 102 (43.78%) infector-infectee pairs, transmission occurred before infectors’ symptom onsets. In 27 (3.92%) infector-infectee pairs, infectees’ symptom onsets occurred before those of infectors. Stratified analysis showed that incubation period and serial interval were consistently longer for those with less severe disease and for those whose primary cases had less severe disease. Asymptomatic transmission was also observed.InterpretationThis study obtained robust estimates of several key epidemiological parameters of COVID-19. The findings support current practice of 14-day quarantine of persons with potential exposure, but also suggest that longer monitoring periods might be needed for selected groups. The estimates of serial interval, time point of exposure and latent period provide consistent evidence on pre-symptomatic transmission. This together with asymptomatic transmission and the generally longer incubation and serial interval of less severe cases suggests a high risk of long-term epidemic in the absence of appropriate control measures.FundingThis work received no funding from any source.

scholarly journals Clinical characteristics and antibody response to SARS-CoV-2 spike 1 protein using VITROS Anti-SARS-CoV-2 antibody tests in COVID-19 patients in Japan

2021 ◽  
Vol 70 (4) ◽  
Author(s):  
Mayu Nagura-Ikeda ◽  
Kazuo Imai ◽  
Katsumi Kubota ◽  
Sakiko Noguchi ◽  
Yutaro Kitagawa ◽  
...  
Keyword(s):  
Antibody Response ◽  
Disease Severity ◽  
Clinical Utility ◽  
Clinical Characteristics ◽  
Igg Antibody ◽  
Laboratory Findings ◽  
Disease Prognosis ◽  
Antibody Assays ◽  
Clinical Records ◽  
Antibody Tests

Introduction. Serological tests for COVID-19 are important in providing results for surveillance and supporting diagnosis. Investigating the serological response in COVID-19 patients with different disease severity is important for assessing the clinical utility of serological assays. Gap Statement. However, few studies have investigated the clinical utility of antibody assays for COVID-19 or differences in antibody response in association with disease severity. Aim. The study aimed to evaluate the clinical characteristics and clinical utility of VITROS SARS-CoV-2 antibody tests according to COVID-19 severity in patients in Japan. Methodology. We analysed 255 serum specimens from 130 COVID-19 patients and examined clinical records and laboratory data. Presence of total (IgA, IgM, and IgG) and specific IgG antibody for the spike 1 antigen of SARS-CoV-2 was determined using VITROS Anti-SARS-CoV-2 antibody tests. Results. Overall, 98 (75.4 %) and 32 (24.6 %) patients had mild and severe COVID-19, respectively. On admission, 76 (58.5 %) and 45 (34.6 %) patients were positive for total and IgG antibody assays. Among 91 patients at discharge, 90 (98.9 %) and 81 (89.0 %) were positive for total and IgG antibody, respectively. Clinical background and laboratory findings on admission, but not the prevalence or concentration of total or IgG antibody, were associated with disease prognosis. Total and IgG antibody intensities were significantly higher in severe cases than in mild cases in serum collected >11 days after onset, but not within 10 days. Conclusion. VITROS Anti-SARS-CoV-2 total and IgG assays will be useful as supporting diagnostic and surveillance tools and for evaluation of humoral immune response to COVID-19. Optimal prediction of disease prognosis is made from considering both clinical history and laboratory findings.

Severe respiratory viral infection induces procalcitonin in the absence of bacterial pneumonia

Thorax ◽  
2020 ◽  
Vol 75 (11) ◽  
pp. 974-981 ◽  
Author(s):  
Samir Gautam ◽  
Avi J Cohen ◽  
Yannick Stahl ◽  
Patricia Valda Toro ◽  
Grant M Young ◽  
...  
Keyword(s):  
Viral Infection ◽  
Disease Severity ◽  
Influenza Infection ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Antibiotic Administration ◽  
Underlying Assumption ◽  
Cellular Models ◽  
Interferon Signalling ◽  
Bacterial Coinfection

IntroductionProcalcitonin expression is thought to be stimulated by bacteria and suppressed by viruses via interferon signalling. Consequently, during respiratory viral illness, clinicians often interpret elevated procalcitonin as evidence of bacterial coinfection, prompting antibiotic administration. We sought to evaluate the validity of this practice and the underlying assumption that viral infection inhibits procalcitonin synthesis.MethodsWe conducted a retrospective cohort study of patients hospitalised with pure viral infection (n=2075) versus bacterial coinfection (n=179). The ability of procalcitonin to distinguish these groups was assessed. In addition, procalcitonin and interferon gene expression were evaluated in murine and cellular models of influenza infection.ResultsPatients with bacterial coinfection had higher procalcitonin than those with pure viral infection, but also more severe disease and higher mortality (p<0.001). After matching for severity, the specificity of procalcitonin for bacterial coinfection dropped substantially, from 72% to 61%. In fact, receiver operating characteristic curve analysis showed that procalcitonin was a better indicator of multiple indices of severity (eg, organ failures and mortality) than of coinfection. Accordingly, patients with severe viral infection had elevated procalcitonin. In murine and cellular models of influenza infection, procalcitonin was also elevated despite bacteriologic sterility and correlated with markers of severity. Interferon signalling did not abrogate procalcitonin synthesis.DiscussionThese studies reveal that procalcitonin rises during pure viral infection in proportion to disease severity and is not suppressed by interferon signalling, in contrast to prior models of procalcitonin regulation. Applied clinically, our data suggest that procalcitonin represents a better indicator of disease severity than bacterial coinfection during viral respiratory infection.

scholarly journals Dynamic change and clinical relevance of post-infectious SARS-CoV-2 antibody responses

2021 ◽  
Author(s):  
P W G Mallon ◽  
W Tinago ◽  
A Garcia Leon ◽  
K McCann ◽  
G Kenny ◽  
...  
Keyword(s):  
Disease Severity ◽  
Symptom Onset ◽  
Post Infection ◽  
Dynamic Change ◽  
Severe Disease ◽  
Additive Models ◽  
Antibody Responses ◽  
Rapid Decline ◽  
Relative Differences ◽  
Post Infectious

Abstract Background Although reports suggest that most individuals with COVID-19 develop detectable antibodies post infection, the kinetics, durability, and relative differences between IgM and IgG responses beyond the first few weeks after symptom onset remain poorly understood. Methods Within a large, well-phenotyped, diverse, prospective cohort of subjects with and without SARS-CoV-2 PCR-confirmed infection and historical controls derived from cohorts with high prevalence of viral coinfections and samples taken during prior flu seasons, we measured SARS-CoV-2 serological responses (both IgG and IgM) using commercially available assays. We calculated sensitivity and specificity, relationship with disease severity and mapped the kinetics of antibody responses over time using generalised additive models. Results We analysed 1,001 samples from 752 subjects, 327 with confirmed SARS-CoV-2 (29.7% with severe disease) spanning a period of 90 days from symptom onset. Sensitivity was lower (44.1-47.1%) early (&lt;10 days) after symptom onset but increased to &gt;80% after 10 days. IgM positivity increased earlier than IgG-targeted assays but positivity peaked between day 32 and 38 post onset of symptoms and declined thereafter, a dynamic that was confirmed when antibody levels were analysed, with more rapid decline observed with IgM. Early (&lt;10 days) IgM but not IgG levels were significantly higher in those who subsequently developed severe disease (signal / cut-off 4.20 (0.75-17.93) versus 1.07 (0.21-5.46), P=0.048). Conclusions This study suggests that post-infectious antibody responses in those with confirmed COVID-19 begin to decline relatively early post infection and suggests a potential role for higher IgM levels early in infection predicting subsequent disease severity

scholarly journals Dynamic change and clinical relevance of post-infectious SARS-CoV-2 antibody responses

2021 ◽  
Author(s):  
PWG Mallon ◽  
W Tinago ◽  
A Garcia Leon ◽  
K McCann ◽  
G Kenny ◽  
...  
Keyword(s):  
Disease Severity ◽  
Symptom Onset ◽  
Post Infection ◽  
Dynamic Change ◽  
Severe Disease ◽  
Additive Models ◽  
Antibody Responses ◽  
Rapid Decline ◽  
Relative Differences ◽  
Post Infectious

AbstractBackgroundAlthough reports suggest that most individuals with COVID-19 develop detectable antibodies post infection, the kinetics, durability, and relative differences between IgM and IgG responses beyond the first few weeks after symptom onset remain poorly understood.MethodsWithin a large, well-phenotyped, diverse, prospective cohort of subjects with and without SARS-CoV-2 PCR-confirmed infection and historical controls derived from cohorts with high prevalence of viral coinfections and samples taken during prior flu seasons, we measured SARS-CoV-2 serological responses (both IgG and IgM) using commercially available assays. We calculated sensitivity and specificity, relationship with disease severity and mapped the kinetics of antibody responses over time using generalised additive models.ResultsWe analysed 1,001 samples from 752 subjects, 327 with confirmed SARS-CoV-2 (29.7% with severe disease) spanning a period of 90 days from symptom onset. Sensitivity was lower (44.1-47.1%) early (<10 days) after symptom onset but increased to >80% after 10 days. IgM positivity increased earlier than IgG-targeted assays but positivity peaked between day 32 and 38 post onset of symptoms and declined thereafter, a dynamic that was confirmed when antibody levels were analysed, with more rapid decline observed with IgM. Early (<10 days) IgM but not IgG levels were significantly higher in those who subsequently developed severe disease (signal / cut-off 4.20 (0.75-17.93) versus 1.07 (0.21-5.46), P=0.048).ConclusionsThis study suggests that post-infectious antibody responses in those with confirmed COVID-19 begin to decline relatively early post infection and suggests a potential role for higher IgM levels early in infection predicting subsequent disease severity.

scholarly journals Prognostic value of sTREM-1 in COVID-19 patients: a biomarker for disease severity and mortality

2020 ◽  
Author(s):  
Pedro V da Silva Neto ◽  
Jonatan C S de Carvalho ◽  
Vinicius E Pimentel ◽  
Malena M Perez ◽  
Ingryd Carmona-Garcia ◽  
...  
Keyword(s):  
Disease Severity ◽  
Clinical Characteristics ◽  
Early Recognition ◽  
Severe Disease ◽  
Critical Role ◽  
Critical Groups ◽  
Receiver Operating Curve ◽  
Mild Disease ◽  
Clinical Scores ◽  
Novel Coronavirus

Background: The uncontrolled inflammatory response plays a critical role in the novel coronavirus disease (COVID-19) and triggering receptor expressed on myeloid cells-1 (TREM-1) is thought to be intricate to inflammatory signal amplification. This study aims to investigate the association between soluble TREM-1 (sTREM-1) and COVID-19 as a prognostic biomarker to predict the disease severity, lethality and clinical management.Methods: We enrolled 91 patients with COVID-19 in domiciliary care (44 patients) or in hospital care (47 patients), who were classified after admission into mild, moderate, severe and critical groups according to their clinical scores. As non-COVID-19 control, 30 healthy volunteers were included. Data on demographic, comorbidities and baseline clinical characteristics were obtained from their medical and nurse records. Peripheral blood samples were collected at admission and after hospitalization outcome to assess cytokine profile and sTREM-1 level by specific immunoassays Results: Within COVID-19 patients, the highest severity was associated with the most significant elevated plasma levels sTREM-1. Using receiver operating curve analysis (ROC), sTREM-1 was found to be predictive of disease severity (AUC= 0.988) and the best cut-off value for predicting in-hospital severity was ≥ 116.5 pg/mL with the sensitivity for 93.3% and specificity for 95.8%. We also described the clinical characteristics of these patients and explored the correlation with markers of the disease aggravation. The levels of sTREM-1 were positively correlated with IL-6, IL-10, blood neutrophils counts, and critical disease scoring (r= 0.68, p<0.0001). On the other hand, sTREM-1 level was significantly negative correlated with lymphocytes counting, and mild disease (r= -0.42, p<0.0001). Higher levels of sTREM-1 were related to poor outcome and death, patients who received dexamethasone tended to have lower sTREM-1 levels. Conclusion: Our results indicated that sTREM-1 in COVID-19 is associated with severe disease development and a prognostic marker for mortality. The use of severity biomarkers such as sTREM-1 together with patients clinical scores could improve the early recognition and monitoring of COVID-19 cases with higher risk of disease worsening. Key words: COVID-19; sTREM-1; Inflammation; Biomarker; Severity; Mortality.

scholarly journals Clinical characteristics of foodborne botulism in the southern region of the Kyrgyz Republic

2020 ◽  
Vol 10 (3) ◽  
pp. 581-586
Author(s):  
S. T. Salieva ◽  
S. T. Zholdoshev
Keyword(s):  
Incubation Period ◽  
Disease Severity ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Acute Onset ◽  
Southern Region ◽  
Nasolabial Fold ◽  
Kyrgyz Republic ◽  
Short Incubation Period ◽  
Hands And Feet

The main factors of botulism transmission are identified as home-canned products (vegetable salads, fruit compotes, seaberry jam), pickled cucumbers and tomatoes. Botulism proceeds clinically as moderate-to-severe disease. High prevalence of type A and untypeable C. botulinum toxins along with type B species in the southern region accounts for its severe course. In our study, clinical manifestations of botulism were presented by moderate and severe clinical picture in 72.3% (47 patients) and 27.7% (18 patients) cases. No mild forms of the disease were diagnosed. Length of incubation period in examined patients on average was 13.6 hours. Upon that, a short incubation period was observed after consumption of canned fruit compote and sea buckthorn jam, cucumbers and tomatoes (16 subjects) or canned vegetables (38 subjects) on average ranging from 4 to 8 hours, 8 hours to 1 day, or 15 hours to 1.5 days, respectively. All subjects were featured with acute onset manifested as general intoxication and gastrointestinal syndromes. The former was characterized by headache, dizziness, and severe general weakness. Subfebrile temperature (37.1–37.5°C) was noted in patients with a short incubation period. Such syndrome in case of moderate disease course was also characterized by moderate severity in 70.2±6.7% cases, with acute appearance in 29.8±6.9% cases; in severe course it was featured with extremely severe course (100%), and in one case it resulted in lethal outcome. Intensity and persistence of neurological disorders clearly correlated with the disease severity, which pointed at its progression. Upon admission to the hospital, patients noted moderate and marked dry mouth in 63.1±5.9% and 36.9±5.9% cases, respectively. Ophthalmoplegic syndrome was characterized by: doubling of object contours, diplopia, limited eye movement, mydriasis, lethargy or lack of pupillary reaction to light, anisocoria, and ptosis. Phagonazoglossoneurological syndrome was early manifested by swallowing problem. Next, tongue deviation, amimia, flattened nasolabial fold, and soft palate paresis were added up. Phonolaryngology syndrome was evident depending on disease severity in a form of varying intensity of dysphonia and dysarthria. Syndrome of general myoneuroplegia was characterized by lowered strength in hands and feet.

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