Contrasting SARS-CoV-2 RNA copies and clinical symptoms in a large cohort of Colombian patients during the first wave of the COVID-19 pandemic

Abstract Background There is limited and controverting evidence looking at possible associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copies and patient variables in large cohorts of symptomatic and asymptomatic patients. Methods We studied 2275 symptomatic and asymptomatic patients from Colombia with coronavirus disease 2019 (COVID-19) and analyzed the associations between RT-PCR cycle threshold (Ct) value with gender, age, comorbidities, symptomatology, and disease severity. Results 15.4 % of the samples (n = 428) reported at least one comorbidity. There were 2011 symptomatic cases (72.4 %), being the most common reported symptom cough (57.2 %, n = 1586). Respiratory distress was present in 21.4 % of patients (n = 595), and 435 patients (15.6 %) required hospital admission. We observed that patients with no prior medical history harbored higher RNA copies than patients with comorbidities (p = 0.02). No significant differences in RNA copies were observed between symptomatic and asymptomatic patients (p = 0.82). Strong correlations were detected between Ct values and the presence of odynophagia (p = 0.03), diarrhea (p = 0.04), and headache (p = 0.0008). An inverse association was found between RNA copy number and markers of disease severity, namely, respiratory distress (P < 0.0001) and hospitalization requirement (P < 0.0001). Conclusions SARS-CoV-2 RT-PCR cycle thresholds reveal strong associations with a prior medical history, specific symptomatology, and disease severity markers. Further research controlling potential confounding variables needs to be conducted to evaluate the nature and usefulness of these associations in managing COVID-19 patients.

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Simultaneous enterovirus EV-D68 and CVA6 infections causing acute respiratory distress syndrome and hand, foot and mouth disease

Virology Journal ◽

10.1186/s12985-021-01560-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Ivanildo Pedro de Sousa ◽

Heloísa Ihle Giamberardino ◽

Sonia Mara Raboni ◽

Maria Carmo Debur ◽

Maria de Lourdes Aguiar Oliveira ◽

...

Keyword(s):

Respiratory Distress ◽

Clinical Symptoms ◽

Foot And Mouth Disease ◽

Mouth Disease ◽

Rt Pcr ◽

Double Infection ◽

Chinese Strain ◽

Case Presentation ◽

Foot And Mouth ◽

Shed Light

Abstract Background Although most enterovirus (EV) infections can be asymptomatic, these viral agents can cause serious conditions associated with central nervous system, respiratory disease and uncommon manifestations of hand, foot and mouth disease (HFMD). EV-coinfections have been rarely reported with development of complications and severe clinical outcome. An atypical case of a child presenting HFMD and severe acute respiratory syndrome, co-infected with EV-D68 and CVA6, is reported herein. Case presentation A 3-year-old boy was admitted in the emergency department unit showing fever, abdominal pain and tachycardia. Twenty-four hours after hospitalization the child developed severe clinical symptoms associated with HFMD and was discharged after recovery. Two days later, the child was readmitted with fever, cough and respiratory distress. RT-PCR and Sanger sequencing confirmed positivity for EV-D68 and CVA6 in oro and nasopharynges swabs and vesicles fluid, respectively. Phylogenetic analysis based on VP1 gene sequences suggested that CVA6 was closely related with HFMD viruses circulating in Turkey, while EV-D68 was genetically related to a Chinese strain. Conclusions To the best of our knowledge, this case is the first report of a double infection caused by CVA6 and EV-D68, which shed light on the pathogenesis of enterovirus infections. Further studies must be conducted to ascertain the role and clinical significance of EV co-infections, as well as a potential synergistic pathway between these viruses.

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A prospective, open label clinical study to evaluate the safety, efficacy and tolerability of azadvir herbal steam inhaler in asymptomatic, mildly symptomatic COVID-19 patients and health care workers posted to covid wards

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20211018 ◽

2021 ◽

Vol 10 (4) ◽

pp. 373

Author(s):

Ajitha Pottirayil ◽

Shankar A. S. ◽

Shaji Kannoth ◽

Poorna Prasad ◽

Sharath Kumar B. Jaikar ◽

...

Keyword(s):

Clinical Symptoms ◽

Standard Of Care ◽

P Value ◽

Rt Pcr ◽

Immune Markers ◽

Open Label ◽

Asymptomatic Group ◽

Asymptomatic Patients ◽

Study Results ◽

D Dimer

Background: COVID-19 patients experience cytokine storm which cause pulmonary and extra-pulmonary complications even with currently available of standard of care. Additional antiviral and immune boosters are the need of hour to treat COVID-19 and to prevent post covid complications.Methods: In this study we enrolled 40 asymptomatic to mild COVID-19 patients to receive azadvir herbal steam inhaler along with standard of care. We evaluated the benefits of azadvir herbal steam inhaler by assessing RT-PCR conversion, clinical outcomes and improvement in immune markers (LDH, CRP, D-DIMER).Results: At the end of the study the immune markers improved significantly in study patients. In mild symptomatic cases IL-6 was 23.2 pg/ml on day 0 and 21.8 pg/ml on day 14. Reduction in IL-6 in mild symptomatic patients was statistically highly significant (p=0.0056). Mean IL-6 in asymptomatic patients was 22.3 pg/ml on day 0 and 21.1 pg/ml on day 14. Reduction in IL-6 in asymptomatic patients was statistically highly significant (p=0.0035). Mean D-dimer was showing decreasing trend from day 0 to day 14 in mild symptomatic patients. In asymptomatic patients D dimer was 0.8 µg/ml on day 0 and 0.6 µg/ml on day 14. D-dimer decreased significantly from day 0 to day 14 (p value =0.0013). Mean LDH values on day 0 in mild symptomatic patients was 319.4 U/l and 219.3 on day 14. The reduction in LDH values in mild symptomatic patients is statistically significant (p value <0.0122). In asymptomatic patients mean LDH values on day 0 was 237 U/l and 194 U/l on day 14. The reduction in LDH values in asymptomatic group was statistically significant. Mean CRP values in mild symptomatic patients on day 0 was 12.2 mg/l and 3.8 mg/l on day 14. There was significant reduction in CRP values in mild symptomatic group which was statistically significant (p value =0.0546). Mean CRP values in asymptomatic patients on day 0 was 4.9 mg/l and 2.8 mg/l on day 14. There was significant reduction in mean CRP in asymptomatic patients which was statistically significant (p value =0.0446). In the present study all 40 patients (100%) cleared the virus and became negative for RT PCR test within 6 days. None of the patients progressed to severe COVID-19 and none of the patients succumbed to the disease.Conclusions: Azadvir accelerated recovery of COVID-19 patients by RT-PCR conversion, early improvement in clinical symptoms and immune markers in this study. This study results clearly indicates that azadvir has antiviral, immune booster activity and has definitive role in the management of asymptomatic to mild COVID-19 patients along with standard of care (CTRI no. CTRI/2020/06/026181).

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All four dengue virus serotypes co-circulate in concurrent dengue infections in a single dengue session in Chittagong, Bangladesh

Bioresearch Communications ◽

10.3329/brc.v8i1.57042 ◽

2021 ◽

Vol 8 (1) ◽

pp. 1042-1048

Author(s):

Moushumi Ghosh Roy ◽

Kutub Uddin ◽

Din Islam ◽

Anjuvan Singh ◽

Mohammad Monirul Islam

Keyword(s):

Dengue Virus ◽

Dengue Fever ◽

Disease Severity ◽

Clinical Symptoms ◽

Global Public Health ◽

Rt Pcr ◽

Serum Samples ◽

Dengue Disease ◽

Denv Serotypes ◽

Public Health Burden

Purposes: Dengue fever, a mosquito-borne viral disease, is a global public health burden affecting millions of people each year and over 40% of world populations are at risk of dengue. Therefore, prompt and accurate dengue diagnosis is inevitable for disease surveillance and for aiding disease management. In this study we report dengue virus (DENV) seroprevalence in Chittagong, Bangladesh along with clinical manifestation of dengue infections. Methods: All samples included in this study were selected based on dengue NS1-based diagnosis, clinical sign and symptoms were judged by expert clinical physicians and infecting DENV serotyping was done by RT-PCR. The blood cells (Platelet, Haematocrit, WBC etc) were analyzed using Haematology cell counter. Results: First, among the 112 DENV infected serum samples tested by RT-PCR, 42 were DENV positive where 76% samples had single DENV serotype infection and 24% were concurrently infected with two or more DENV serotypes, indicating that all four DENVs were present in a single dengue session in Chittagong, Bangladesh. Then, DENV4 was the most prevailed serotype, followed by DENV2, DENV1 and DENV3 in single DENV serotype infections. However, in almost 90% cases of concurrent multiple DENV infections DENV1 serotype was present. A detail analysis of clinical data clearly indicated that DENV1 and DENV2 resulted very similar patterns of clinical symptoms which were quite different from those caused by DENV3 and DENV4. For example, ache and pain were absent in DENV3 infection and diarrhea was absent in DENV4 infections. Furthermore, DENV3, both in single and concurrent multiple DENV infections, might increase dengue disease severity as observed highly reduced platelet counts along with increased WBC in patients infected with DENV3 serotype. Conclusion: All four DENV serotypes, both as single and concurrent multiple DENV infections, were present in single dengue session in Bangladesh. Despite having very similar sequences and structures all four DENVs might produce different disease spectra, ranging from classical dengue fever to dengue hemorrhagic fever. Concurrent multiple DENV infections could contribute increased dengue disease severity in dengue outbreaks in Bangladesh. Bioresearch Commu. 8(1): 1042-1048, 2022 (January)

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Incidentally recognized COVID-19 pneumonia in routine oncologic 18F-FDG PET/CT examinations: a local experience during pandemic era

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00333-9 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Susan Adil Ali ◽

Moustafa Mahmoud Abdelkawi

Keyword(s):

Fdg Pet ◽

Clinical Symptoms ◽

Incidental Finding ◽

Whole Body ◽

Rt Pcr ◽

Asymptomatic Patients ◽

Local Experience ◽

Pet Ct ◽

Fdg Pet Ct ◽

Spread Of Infection

Abstract Background CT chest findings of COVID-19 pneumonia can be detected before the clinical symptoms become evident in many cases. In this work, we presented our experience in incidental detection of COVID-19-associated pneumonia in asymptomatic patients coming for routine oncologic 18F-FDG PET/CT examinations during the COVID-19 pandemic, which contribute in the detection of the affected patients early to be isolated and properly managed. We reported the cases with incidental finding of COVID-19 pneumonia among 764 asymptomatic patients who were referred for whole-body 18F-FDG PET/CT examinations for routine oncologic indications in the period between 15 March and 15 June 2020, and RT-PCR testing for them was requested for confirmation. Results Among the 764 scanned patients, we had recognized 87 patients (11.3%) having features of COVID-19 pneumonia. RT-PCR testing of them confirmed COVID-19 infection in 78 cases, yet 3 were negative and no RT-PCR testing was performed in 6 cases (only isolated and carefully monitored). Conclusion 18F-FDG PET/CT is sensitive for early COVID-19 detection, even in asymptomatic patients that guide proper management and also highlight the key role of a radiologist and the importance of applying safety measures in clinical services during the pandemic to minimize the spread of infection.

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Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2011.marapr02 ◽

2011 ◽

Vol 16 (2) ◽

pp. 8-9

Author(s):

Marjorie Eskay-Auerbach

Keyword(s):

Clinical Symptoms ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Disc Space Narrowing ◽

Disc Disease ◽

Disc Space ◽

Radiographic Findings ◽

Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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Scoring System for the Diagnosis of COVID-19

The Open Public Health Journal ◽

10.2174/1874944502013010413 ◽

2020 ◽

Vol 13 (1) ◽

pp. 413-414 ◽

Cited By ~ 1

Author(s):

Mohamed Farouk Allam

Keyword(s):

Scoring System ◽

Clinical Symptoms ◽

False Negative ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Pcr Assay ◽

Negative Results ◽

False Negative Results ◽

Symptoms And Signs

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

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Viral Dynamics and Real-Time RT-PCR Ct Values Correlation with Disease Severity in COVID-19

Diagnostics ◽

10.3390/diagnostics11061091 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1091

Author(s):

Ali A. Rabaan ◽

Raghavendra Tirupathi ◽

Anupam A Sule ◽

Jehad Aldali ◽

Abbas Al Mutair ◽

...

Keyword(s):

Viral Load ◽

Real Time ◽

Disease Severity ◽

False Negative ◽

Influential Factors ◽

Confirmatory Test ◽

Acid Extraction ◽

Rt Pcr ◽

Viral Kinetics ◽

Ct Value

Real-time RT-PCR is considered the gold standard confirmatory test for coronavirus disease 2019 (COVID-19). However, many scientists disagree, and it is essential to understand that several factors and variables can cause a false-negative test. In this context, cycle threshold (Ct) values are being utilized to diagnose or predict SARS-CoV-2 infection. This practice has a significant clinical utility as Ct values can be correlated with the viral load. In addition, Ct values have a strong correlation with multiple haematological and biochemical markers. However, it is essential to consider that Ct values might be affected by pre-analytic, analytic, and post-analytical variables such as collection technique, specimen type, sampling time, viral kinetics, transport and storage conditions, nucleic acid extraction, viral RNA load, primer designing, real-time PCR efficiency, and Ct value determination method. Therefore, understanding the interpretation of Ct values and other influential factors could play a crucial role in interpreting viral load and disease severity. In several clinical studies consisting of small or large sample sizes, several discrepancies exist regarding a significant positive correlation between the Ct value and disease severity in COVID-19. In this context, a revised review of the literature has been conducted to fill the knowledge gaps regarding the correlations between Ct values and severity/fatality rates of patients with COVID-19. Various databases such as PubMed, Science Direct, Medline, Scopus, and Google Scholar were searched up to April 2021 by using keywords including “RT-PCR or viral load”, “SARS-CoV-2 and RT-PCR”, “Ct value and viral load”, “Ct value or COVID-19”. Research articles were extracted and selected independently by the authors and included in the present review based on their relevance to the study. The current narrative review explores the correlation of Ct values with mortality, disease progression, severity, and infectivity. We also discuss the factors that can affect these values, such as collection technique, type of swab, sampling method, etc.

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Prolonged SARS-CoV-2-RNA Detection from Nasopharyngeal Swabs in an Oncologic Patient: What Impact on Cancer Treatment?

Current Oncology ◽

10.3390/curroncol28010083 ◽

2021 ◽

Vol 28 (1) ◽

pp. 847-852

Author(s):

Anna Ferrari ◽

Marco Trevenzoli ◽

Lolita Sasset ◽

Elisabetta Di Liso ◽

Toni Tavian ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Treatment ◽

Cancer Patients ◽

Clinical Symptoms ◽

Palliative Radiotherapy ◽

Rt Pcr ◽

Cancer Treatments ◽

Global Challenge ◽

Viral Culture ◽

Pcr Assays

The pandemic of SARS-CoV-2 is a serious global challenge affecting millions of people worldwide. Cancer patients are at risk for infection exposure and serious complications. A prompt diagnosis of SARS-CoV-2 infection is crucial for the timely adoption of isolation measures and the appropriate management of cancer treatments. In lung cancer patients the symptoms of infection 19 may resemble those exhibited by the underlying oncologic condition, possibly leading to diagnostic overlap and delays. Moreover, cancer patients might display a prolonged positivity of nasopharyngeal RT-PCR assays for SARS-CoV-2, causing long interruptions or delay of cancer treatments. However, the association between the positivity of RT-PCR assays and the patient’s infectivity remains uncertain. We describe the case of a patient with non-small cell lung cancer, and a severe ab extrinseco compression of the trachea, whose palliative radiotherapy was delayed because of the prolonged positivity of nasopharyngeal swabs for SARS-CoV-2. The patient did not show clinical symptoms suggestive of active infection, but the persistent positivity of RT-PCR assays imposed the continuation of isolation measures and the delay of radiotherapy for over two months. Finally, the negative result of SARS-CoV-2 viral culture allowed us to verify the absence of viral activity and to rule out the infectivity of the patient, who could finally continue her cancer treatment.

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Implementing SARS-CoV-2 Rapid Antigen Testing in the Emergency Ward of a Swiss University Hospital: The INCREASE Study

Microorganisms ◽

10.3390/microorganisms9040798 ◽

2021 ◽

Vol 9 (4) ◽

pp. 798

Author(s):

Giorgia Caruana ◽

Antony Croxatto ◽

Eleftheria Kampouri ◽

Antonios Kritikos ◽

Onya Opota ◽

...

Keyword(s):

Immunoglobulin A ◽

University Hospital ◽

Lower Sensitivity ◽

Clinical Settings ◽

Rt Pcr ◽

Emergency Ward ◽

Viral Loads ◽

Asymptomatic Patients ◽

Asymptomatic Subjects ◽

Antigen Testing

Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients’ cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q®, PanbioTM and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q®, PanbioTM and BD Veritor™, respectively, for viral loads above 105 copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 106 copies/mL and 100% for viral loads above 107 copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.

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Retinal microvascular signs in COVID-19

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318236 ◽

2021 ◽

pp. bjophthalmol-2020-318236

Author(s):

Ralene Sim ◽

Gemmy Cheung ◽

Daniel Ting ◽

Edmund Wong ◽

Tien Yin Wong ◽

...

Keyword(s):

Medical History ◽

Vital Signs ◽

Plexiform Layer ◽

Nasopharyngeal Swab ◽

Inner Plexiform Layer ◽

Cross Sectional ◽

Imaging Device ◽

Asymptomatic Patients ◽

Significant Difference ◽

Retinal Microvascular Signs

Background/aimsTo explore if retinal findings are associated with COVID-19 infection.MethodsIn this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records.Results108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs—eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03).ConclusionOne in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.

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