Prolonged Viral Shedding in Patients with Mild to Moderate COVID-19 Disease: A Regional Perspective

Background The risk of transmission of Coronavirus Disease 2019 (COVID-19) is increasingly understood to be greatest early after symptom onset, however, factors associated with prolonged and increased risk of transmission remain unclear. In settings where COVID-19 prevalence is low, there may be a benefit of extending the period that patients are isolated to decrease the risk of transmission. This study explored the duration of viral shedding in such a location, in patients with mild-moderate COVID-19 disease in Ballarat, Australia. Methods Patients diagnosed with COVID-19 disease using a real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay from oropharyngeal and bilateral deep nasopharyngeal sampling and managed through Ballarat Health Services between March 1 and May 1, 2020 were included. Patients were retested if they were afebrile for >72 hours, asymptomatic and >14 days since symptom onset. If positive on retesting, patients were tested every 3 to 7 days thereafter. Results Patients underwent testing a median of 4 days (range 1-12) after initial symptom onset. Duration of symptoms ranged from 1 to 36 days. Positive tests were recorded up to a median of day 21 (range 6-38). Cycle thresholds were inversely correlated with time since symptom onset ( P < .0001). Median time to the first negative test was 25 days (range 12-32). Two patients who had remained asymptomatic for >7 days after initial symptom onset had recrudescence of mild symptoms on day 13 and 14; both tested positive on follow-up tests at this time. Conclusions This study demonstrates prolonged shedding of COVID-19 in patients with mild-moderate disease. It suggests that some patients with mild disease may have recrudescence of symptoms a week or more after their initial symptoms resolved.

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Longest reported case of symptomatic COVID-19 reporting positive for over 230 days in an immunocompromised patient in the United States

SAGE Open Medical Case Reports ◽

10.1177/2050313x211040028 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110400

Author(s):

Bilal Chaudhry ◽

Lidiya Didenko ◽

Maaria Chaudhry ◽

Andrew Malek ◽

Kirill Alekseyev

Keyword(s):

Risk Factors ◽

Polymerase Chain Reaction ◽

Immunocompromised Patient ◽

The United States ◽

Immunocompromised Patients ◽

Chain Reaction ◽

Viral Shedding ◽

Time Period ◽

Increased Risk ◽

Polymerase Chain

Coronavirus 2019 (COVID-19) pneumonia was first noted in Wuhan, China. Since the start of the pandemic, there have been millions of cases diagnosed. The average time from onset of symptoms to testing negative SARS-CoV-2 via reverse transcription polymerase chain reaction is roughly 25 days. In patients who continually test positive for COVID-19, it is essential to determine precisely which risk factors contribute to the increase in viral shedding duration. We present a case about a 62-year-old man who has persistently tested positive for COVID-19 for more than 230 days. We followed his treatment course, in which he had been hospitalized multiple times since the onset of symptoms back in April 2020. We have determined that patients with immunosuppression, especially those taking corticosteroids, are at increased risk of prolonged viral shedding. It is essential to continually monitor these immunocompromised patients as they required a greater time period in order to have an appropriate immune response in which antibodies are created.

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Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

Cartilage ◽

10.1177/1947603520959405 ◽

2020 ◽

pp. 194760352095940

Author(s):

Arnd F. Viehöfer ◽

Fabio Casari ◽

Felix W.A. Waibel ◽

Silvan Beeler ◽

Florian B. Imhoff ◽

...

Keyword(s):

Clinical Outcome ◽

Pearson Correlation ◽

Osteochondral Lesions ◽

Duration Of Symptoms ◽

Ankle Impingement ◽

Increased Risk ◽

Patient Reported ◽

Specific Factors ◽

Anterior Ankle Impingement

Objective To determine potential predictive associations between patient-/lesion-specific factors, clinical outcome and anterior ankle impingement in patients that underwent isolated autologous matrix-induced chondrogenesis (AMIC) for an osteochondral lesion of the talus (OLT). Design Thirty-five patients with a mean age of 34.7 ± 15 years who underwent isolated cartilage repair with AMIC for OLTs were evaluated at a mean follow-up of 4.5 ± 1.9 years. Patients completed AOFAS (American Orthopaedic Foot and Ankle Society) scores at final follow-up, as well as Tegner scores at final follow-up and retrospectively for preinjury and presurgery time points. Pearson correlation and multivariate regression models were used to distinguish associations between patient-/lesion-specific factors, the need for subsequent surgery due to anterior ankle impingement and patient-reported outcomes. Results At final follow-up, AOFAS and Tegner scores averaged 92.6 ± 8.3 and 5.1 ± 1.8, respectively. Both body mass index (BMI) and duration of symptoms were independent predictors for postoperative AOFAS and Δ preinjury to postsurgery Tegner with positive smoking status showing a trend toward worse AOFAS scores, but this did not reach statistical significance ( P = 0.054). Nine patients (25.7%) required subsequent surgery due to anterior ankle impingement. Smoking was the only factor that showed significant correlation with postoperative anterior ankle impingement with an odds ratio of 10.61 when adjusted for BMI and duration of symptoms (95% CI, 1.04-108.57; P = 0.047). Conclusion In particular, patients with normal BMI and chronic symptoms benefit from AMIC for the treatment of OLTs. Conversely, smoking cessation should be considered before AMIC due to the increased risk of subsequent surgery and possibly worse clinical outcome seen in active smokers.

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Hemisensory paresthesia as the initial symptom of a SARS-Coronavirus-2 infection. A Case report.

10.21203/rs.3.rs-26305/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Myriam Herrnberger ◽

Nadine Durmazel ◽

Frank Birklein

Keyword(s):

Case Report ◽

Side Effects ◽

Viral Infection ◽

Viral Infections ◽

Neurological Symptoms ◽

Initial Symptom ◽

Mild Disease ◽

Initial Symptoms ◽

Patient Reported ◽

Neurological Presentation

Abstract Neurological symptoms might be associated with a Covid-19 infection. There are frequent reports in the last weeks. The neurological symptoms range from harmless side effects of a viral infection to meningoencephalitis and acute haemorrhagic necrotizing encephalopathy.Our patient reported burning headache and paresthesia as the initial symptoms mainly without other signs of viral infection like cough or fever. Such an initial neurological presentation seems to be rare. Most cases have neurological symptoms which can be expected after severe systemic viral infections like fever associated headache. Many COVID-19 patients with mild disease are at home and the further course is unknown. Our case shows, that neurological symptoms can be the first manifestation of an COVID-19 disease. While restricted paraesthesia has been reported in SARS-CoV-2 infections, hemisymptoms have not been described as initial symptoms.

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Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation

Journal of Neurosurgery Spine ◽

10.3171/2012.7.spine12272 ◽

2012 ◽

Vol 17 (5) ◽

pp. 381-387 ◽

Cited By ~ 29

Author(s):

Alex Alfieri ◽

Giampietro Pinna

Keyword(s):

Craniocervical Junction ◽

Long Term Results ◽

Symptom Duration ◽

Posterior Fossa Decompression ◽

Type I ◽

Duration Of Symptoms ◽

Initial Symptoms ◽

Csf Leakage

Object There is little information about the long-term effectiveness and complications following decompressive surgery for syringomyelia related to Chiari malformation Type I (CM-I). Methods Examining long-term clinical and radiological follow-up, the authors studied a mixed retrospective and prospective single-institution cohort of 109 consecutive surgically treated adult patients with syringomyelia and CM-I. All patients underwent a standardized surgical protocol: decompression of the craniocervical junction, arachnoid exploration, and shrinkage of the cerebellar tonsils. Factors predicting outcome were investigated. Results The retrospective arm consisted of 41 cases treated between 1990 and 1994, and the prospective arm comprised 68 patients treated between 1994 and 2001. The mean overall age was 45.9 years, and 58.8% of the population was female. The median follow-up period was 12.7 years. The most frequent initial symptoms were pain and sensory and gait disturbances. There was no perioperative death or neurological deterioration. The comprehensive perioperative complication rate was approximately 11%, with 3 cases (2.7%) of CSF leakage. Regression analysis showed that the best combination of clinical and radiological outcome predictors was age and duration of symptoms. Clinical follow-up confirmed surgical result stability with clinical improvement of greater than 90% of the spinal and cranial manifestations over a long-term period. Two patients had radiological recurrences of syringomyelia without clinical signs 85 and 124 months after surgery. Conclusions Certain clinical predictors of poor clinical and radiological prognosis were identified—namely, age at time of surgery and symptom duration. The results of the study provide additional long-term data that support the effectiveness and safety of relieving CSF block at the craniocervical junction in CM-I–related syringomyelia.

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Frequency of venous thromboembolism in 6513 patients with COVID-19: a retrospective study

Blood Advances ◽

10.1182/bloodadvances.2020003083 ◽

2020 ◽

Vol 4 (21) ◽

pp. 5373-5377

Author(s):

Jason B. Hill ◽

David Garcia ◽

Mark Crowther ◽

Bryan Savage ◽

Shira Peress ◽

...

Keyword(s):

Emergency Department ◽

Mechanical Ventilation ◽

Venous Thromboembolism ◽

Traditional Approach ◽

Increased Risk ◽

Polymerase Chain ◽

Anticoagulant Prophylaxis ◽

Very High ◽

Overall Mortality

Abstract Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be at increased risk for venous thromboembolism (VTE), especially if they become critically ill with COVID-19. Some centers have reported very high rates of thrombosis despite anticoagulant prophylaxis. The electronic health record (EHR) of a New Orleans–based health system was searched for all patients with polymerase chain reaction–confirmed SARS-CoV-2 infection who were either admitted to hospital or treated and discharged from an emergency department between 1 March 2020 and 1 May 2020. From this cohort, patients with confirmed VTE (either during or after their hospital encounter) were identified by administrative query of the EHR.: Between 1 March 2020 and 1 May 2020, 6153 patients with COVID-19 were identified; 2748 of these patients were admitted, while 3405 received care exclusively through the emergency department. In total, 637 patients required mechanical ventilation and 206 required renal replacement therapy. Within the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 patients (3.1%). In the 637 patients who required mechanical ventilation at some point during their hospital stay, 45 developed VTE (7.2%). After a median follow-up of 14.6 days, VTE had been diagnosed in 3 of the 2075 admitted who were discharged alive (0.14%). Among 6153 patients with COVID-19 who were hospitalized or treated in emergency departments, we did not find evidence of unusually high VTE risk. Pending further evidence from prospective, controlled trials, our findings support a traditional approach to primary VTE prevention in patients with COVID-19.

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COVID-19’s natural course among ambulatory monitored outpatients

Scientific Reports ◽

10.1038/s41598-021-89545-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Barbora Weinbergerova ◽

Jiri Mayer ◽

Stepan Hrabovsky ◽

Zuzana Novakova ◽

Zdenek Pospisil ◽

...

Keyword(s):

Viral Load ◽

Symptom Onset ◽

Interindividual Variability ◽

Initial Symptom ◽

Negative Sample ◽

Ambulatory Patient ◽

Disease Trajectory ◽

High Interindividual Variability ◽

Symptom Status

AbstractResearch objective was to detail COVID-19’s natural trajectory in relation to the Czech population’s viral load. Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19’s impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a 14-day quarantine. Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. Another 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed as symptomatic on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median–19 days). The highest viral load occurred within 0–2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients. No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

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The Reversed Halo Sign in COVID-19 Pneumonia

10.21203/rs.3.rs-20394/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Huifang Zhao ◽

Ting Liang ◽

Carol C. Wu ◽

Chao Jin ◽

Zhe liu ◽

...

Keyword(s):

Symptom Onset ◽

Time Course ◽

Halo Sign ◽

Moderate Disease ◽

Key Points ◽

Reversed Halo Sign ◽

Critical Patients ◽

Peripheral Aspect ◽

Parenchymal Abnormalities

Abstract ObjectivesTo evaluate the frequency and time course of RHS on CT in patient with COVID-19 pneumonia.Materials and methodsA total of 147 patients with COVID-19 pneumonia were divided into mild, moderate, severe and critical categories. The number, location, shape, wall appearance of RHS on CT were analyzed. Other parenchymal abnormalities include GGO, consolidation and linear opacity were also recorded.ResultsRHS was observed in 37 (25.2%) of 147 patients and it was more common in patients with moderate disease than severe or critical disease (31.3% vs. 13.0%, P = 0.019). Time from symptom onset to appearance of RHS was 9 ± 5 days in moderate patients and 14 ± 8 days in severe/critical patients. A total of 64 RHS lesions were identified and the majority of lesions were located in peripheral aspect of lungs (55, 85.9%) and lower lobes (52, 81.2%). All lesions with RHS were round or oval-shaped. The rim of RHS were smooth in 54 (84.4%) and irregular in 10 (15.6%). Follow-up CT scans of 27 patients (50 lesions) showed 43(86%) lesions gradually resolved or developed into GGO and linear opacities and 7(14%) lesions remained unchanged appearance.ConclusionsRHS occurred sooner after symptom onset and with higher frequency in patients with moderate compared to those with severe or critical disease. RHS may represent a favorable prognostic sign in COVID-19 pneumonia.Key Points• 37 (25.2%) of 147 patients with COVID-19 pneumonia had RHS on at least one CT• RHS was more prevalent in patients with moderate disease than those with severe or critical disease• RHSs (78.4%) mostly occurred within 2 weeks after symptom onset

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COVID-19’s Natural Course Among Ambulatory Monitored Outpatients

10.21203/rs.3.rs-148835/v1 ◽

2021 ◽

Author(s):

Barbora Weinbergerova ◽

Jiri Mayer ◽

Stepan Hrabovsky ◽

Zuzana Novakova ◽

Zdenek Pospisil ◽

...

Keyword(s):

Viral Load ◽

Symptom Onset ◽

Interindividual Variability ◽

Initial Symptom ◽

Negative Sample ◽

Ambulatory Patient ◽

Disease Trajectory ◽

High Interindividual Variability ◽

Symptom Status

Abstract Background: Research objective was to detail COVID-19’s natural trajectory in relation to the Czech population’s viral load.Methods: Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19’s impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a fourteen-day quarantine.Results: Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median–19 days). The highest viral load occurred within 0-2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients.Conclusions: No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

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Persistent symptoms in hospitalized patients recovering from COVID-19 in Denmark

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab042 ◽

2021 ◽

Author(s):

S Leth ◽

J D Gunst ◽

V D Mathiasen ◽

K S Hansen ◽

O S Søgaard ◽

...

Keyword(s):

Major Complication ◽

University Hospital ◽

Duration Of Symptoms ◽

Positive Polymerase Chain Reaction ◽

Persistent Symptoms ◽

Research Collaborations ◽

Wide Range ◽

Polymerase Chain ◽

Lost To Follow Up

Abstract Background Although persistent symptoms after Coronavirus disease 2019 (COVID-19) are emerging as a major complication to the infection, data on the diversity and duration of symptoms are needed. Methods Patients aged ≥18 years with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 and hospitalized at the Department of Infectious Diseases, Aarhus University Hospital, Denmark, in the period March 11th to May 15th, were offered follow up after hospitalization. On admission, comprehensive symptom and medical history were collected, including demographic characteristics, duration of symptoms, comorbidities and concomitant medication. At discharge, patients were offered follow-up consultations – either by telephone or in-person visit – at 6 and 12 weeks at our Post-COVID-19 outpatient clinic to assess whether symptoms present at admission had resolved. Results During the inclusion period, 71 patients were admitted with COVID-19. Of these, 10 patients died, 3 were transferred to another region, 4 declined to participate and 5 were lost to follow-up before 12 weeks evaluation. Thus, 49 patients were included. Overall, 96% reported one or more persisting symptoms at 12 weeks follow-up. Main symptoms were fatigue, dyspnea, cough, chemosensory dysfunction, and headache. Conclusion A wide range of persistent symptoms in patients recovering from COVID-19 were present 12 weeks after hospitalization calling for larger descriptive studies and interdisciplinary research collaborations.

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Molecular epidemiology and clinical impact of rhinovirus infections in adults during three epidemic seasons in 11 European countries (2007–2010)

Thorax ◽

10.1136/thoraxjnl-2019-214317 ◽

2020 ◽

Vol 75 (10) ◽

pp. 882-890

Author(s):

Kalina T Zlateva ◽

Anneloes L van Rijn ◽

Peter Simmonds ◽

Frank E J Coenjaerts ◽

Anton M van Loon ◽

...

Keyword(s):

Clinical Impact ◽

European Countries ◽

Acute Cough ◽

Asymptomatic Patients ◽

Patient Symptom ◽

Increased Risk ◽

Polymerase Chain ◽

Asymptomatic Infections ◽

A Prospective Study

BackgroundDifferences in clinical impact between rhinovirus (RVs) species and types in adults are not well established. The objective of this study was to determine the epidemiology and clinical impact of the different RV species.MethodsWe conducted a prospective study of RVs infections in adults with acute cough/lower respiratory tract infection (LRTI) and asymptomatic controls. Subjects were recruited from 16 primary care networks located in 11 European countries between 2007 and 2010. RV detection and genotyping was performed by means of real time and conventional reverse-transcriptase polymerase chain reaction assays, followed by sequence analysis. Clinical data were obtained from medical records and patient symptom diaries.ResultsRVs were detected in 566 (19%) of 3016 symptomatic adults, 102 (4%) of their 2539 follow-up samples and 67 (4%) of 1677 asymptomatic controls. Genotyping was successful for 538 (95%) symptomatic subjects, 86 (84%) follow-up infections and 62 (93%) controls. RV-A was the prevailing species, associated with an increased risk of LRTI as compared with RV-B (relative risk (RR), 4.5; 95% CI 2.5 to 7.9; p<0.001) and RV-C (RR 2.2; 95% CI 1.2 to 3.9; p=0.010). In symptomatic subjects, RV-A loads were higher than those of RV-B (p=0.015). Symptom scores and duration were similar across species. More RV-A infected patients felt generally unwell in comparison to RV-C (p=0·023). Of the 140 RV types identified, five were new types; asymptomatic infections were associated with multiple types.InterpretationIn adults, RV-A is significantly more often detected in cases with acute cough/LRTI than RV-C, while RV-B infection is often found in asymptomatic patients.

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