Feasibility to Reduce Swab RT-PCR Tests by Serum Proteomics for COVID-19 Disease Course Monitoring

Covid-19 is a multi-system infection which predominately infects the lungs. This new disease can present as an asymptomatic infection to life threatening infections leading to death, making it a challenge for healthcare workers across the globe in this pandemic. Covid-19 pneumonia often shows a set pattern of symptom progression along its disease course, although the timing of each symptom may vary in different individuals. In this case report, we will discuss the unusual presentation of a middle-aged man who suffered a prolonged course of disease and who was managed on suspicion of a secondary bacterial infection along with cytokine storm. The logical, thoughtful management options that we chose at various stages of his disease in general ward without use of immune modulatory drug like tocilizumab,which eventually led to his cure are also discussed here.Persistence of positive RT-PCR in the 4th week is also seen in this case.Emphasis is given on how these tricky cases can be dealt in the general ward without shifting them in the HDU, where HDU or ICU facilities are not available or affordable. J Bangladesh Coll Phys Surg 2020; 38(4): 223-228

Download Full-text

The Serum Expression of Selected miRNAs in Pulmonary Sarcoidosis with/without Löfgren’s Syndrome

Mediators of Inflammation ◽

10.1155/2016/1246129 ◽

2016 ◽

Vol 2016 ◽

pp. 1-12 ◽

Cited By ~ 10

Author(s):

Eva Novosadova ◽

Alzbeta Chabronova ◽

Vitezslav Kolek ◽

Martin Petrek ◽

Zdenka Navratilova

Keyword(s):

Cumulative Effect ◽

Pulmonary Sarcoidosis ◽

Good Prognosis ◽

Disease Course ◽

Rt Pcr ◽

Serum Mirnas ◽

Insidious Onset ◽

Extracellular Mirnas ◽

Löfgren’S Syndrome

Purpose. Pulmonary sarcoidosis is associated with dysregulated expression of intracellular miRNAs. There is however only little information on extracellular miRNAs and their association with the disease course in sarcoidosis. We therefore assessed serum miRNAs in sarcoidosis classified according to the presence of Löfgren’s syndrome (LS) as a hallmark of good prognosis in contrast to more advanced disease course. Methods. RT-PCR was used to assess 35 miRNAs in 13 healthy controls and 24 sarcoidosis patients (12 with X-ray (CXR) stage ≤ 1 and LS and 12 with insidious onset and CXR stage ≥ 3). Results. Compared to controls, we consistently observed dysregulated expressions of miR-146, miR-16, miR-425-5p, and miR-93-5p in both sarcoidosis groups irrespective of disease course. Specifically, patients without LS had dysregulated expressions of miR-150-5p, miR-1, and miR-212 compared to controls. Patients with LS had dysregulated expressions of miR-21-5p and miR-340-5p compared to controls. Bioinformatics predicted consistently “Pathways in cancer” to be modulated by both altered profiles in patients with/without LS. Three miRNAs (miR-21-5p, miR-340-5p, and miR-212-3p) differed between our patients with LS and those without LS; their cumulative effect may modulate “TGF-β signalling pathway.” Conclusions. Further study should focus on possible applications of serum miRNAs for diagnostics follow-up and for prognosis.

Download Full-text

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

10.21203/rs.3.rs-16763/v1 ◽

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.

Download Full-text

POS1221 SARS-COV2 SEROLOGY SCREENING IN SPONDYLOARTHRITIS PATIENTS IN NORTH-EASTERN ITALY: A PILOT STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2681 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 894-894

Author(s):

A. Ortolan ◽

C. Cosma ◽

M. Lorenzin ◽

G. Cozzi ◽

A. Doria ◽

...

Keyword(s):

Immune Response ◽

Targeted Therapy ◽

Disease Activity ◽

Disease Activity Score ◽

Severe Disease ◽

Disease Course ◽

Rt Pcr ◽

Positive Serology ◽

Chi Square

Background:Serology could help defining the real extent of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) diffusion in the population, especially in individuals considered at higher risk of SARS-CoV2 infection (COVID-19), such as Spondiloarthritis (SpA) patients undergoing immunosuppressive therapy or health care workers (HCW). In fact, COVID-19 detection is complicated by the fact that many patients can be asymptomatic. In these cases, it has also been suggested that a weaker immune response might be elicited.In this context, the role of anti-cytokine targeted therapy –commonly used as treatment in SpA- is uncertain, as it is not clear whether it is detrimental or protective towards severe disease forms.Objectives:The aim of the study was to explore the potential role of serology in detecting previous contact with SARS-CoV2 in SpA patients and HCW, and compare the frequency of positive findings with a control population.Methods:Consecutive patients affected by axial or peripheral SpA, classified according to Assessment of SpondyloArthritis international Society (ASAS) criteria and undergoing cytokine-targeted therapy, as well as HCW and controls from the pre-COVID-19 era (control group, 2015) were recruited. In SpA patients, disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) and Disease Activity Score on 28-joint-count (DAS28).Sera from all patients were analysed through chemiluminescent analytical system (CLIA) for the presence of IgG and IgM anti-SARS-CoV2. Patients with a positive serological test (either IgM or IgG) additionally underwent real time Polymerase Chain Reaction (RT-PCR) in nasopharyngeal swabs in order to test for active infection. In SpA patients, serology was repeated after 3 months. Data across the 3 groups were compared by ANOVA or Chi-square, while comparison between 2 groups were conducted by Wilcoxon signed rank test or Chi-Square, for continuous and categorical data respectively. P ≤ 0.05 were considered as significant.Results:A total of 396 patients were recruited: 200 SpA, 95 HCW and 101 healthy controls. SpA patients were mostly (54%) males, with mean age 49.6 ±14.7 years, and all were treated with anti-TNFα (78%), anti-IL-17 (9%) and anti-IL-23 drugs (7%), or small molecules (6%). Their disease activity level was moderate-low as assessed by ASDAS (1.95 ±0.98) and DAS28 (2.33 ±2.02). Among HCW and controls, 35% and 62% were male, with mean age 46.7 ±12.9 and 50.6±10.6 respectively.Positive serology (IgM or IgG, or both) was found in 12.5% SpA patients, 8.4% HCW, 0% controls (p=0.001). Among these, IgM titres were higher in the SpA group than in HCW (2.76±2.94 versus 0.80±0.67 KU/L, p= 0.016), while IgG mean titres were lower in the SpA group than in HCW (0.88±3.18 KU/L versus 1.05±0.88, p= 0.035). SpA patients with positive serology more frequently reported COVID-19 like symptoms than those with negative serology (20% vs 4%, p=0.009) and 2 had COVID-19 as confirmed by RT-PCR, none with a severe disease course. None of the HCW reported symptoms or tested positive by RT-PCR. In the SpA patients, at 3 months, the mean IgM titre decreased from 2.76±2.93 to 2.38±2.95 (p=0.001), while the IgG titres decreased from 0.89±3.25 to 0.31±0.87 (p=ns). Interestingly, the IgM or IgG titer at a single-patient level did not seem to change much in terms of absolute value (Figure 1), except in one patient, with documented COVID-19 (positive RT-PCR), in whom IgG level even decreased at 3 months.Conclusion:Serology revealed that exposure to COVID-19 in SpA patients, as well as HCW, was higher than expected based on reported symptoms. Targeted anti-cytokine therapy could act as a protective factor for a severe disease course in SpA patients. However, in this population, IgG and IgM titres did not change in a clinically significant manner at 3 months, and patient did not seem to develop an immune profile consistent with durable response. This result could be due to a weaker immune response in mild infections, but further studies are warranted to clarify the pathophysiology beyond these observations.Figure 1.Disclosure of Interests:Augusta Ortolan: None declared, Chiara Cosma: None declared, Mariagrazia Lorenzin: None declared, Giacomo Cozzi: None declared, Andrea Doria Speakers bureau: Novartis, Abbvie, Pfizer, MSD, Janssen, Glaxosmithkline, Mario Plebani: None declared, Roberta Ramonda Speakers bureau: Novartis, Abbvie, Pfizer, MSD, Janssen

Download Full-text

Differences in clinical severity of respiratory viral infections in hospitalized children

Scientific Reports ◽

10.1038/s41598-021-84423-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Benjamin M. Althouse ◽

Stefan Flasche ◽

Michiko Toizumi ◽

Hien-Anh Thi Nguyen ◽

Hien Minh Vo ◽

...

Keyword(s):

Viral Infections ◽

Fold Increase ◽

Respiratory Viruses ◽

Clinical Severity ◽

Multiple Infections ◽

Hospitalized Children ◽

Disease Course ◽

Rt Pcr ◽

Severity Scores ◽

Concurrent Infections

AbstractIt is uncertain whether clinical severity of an infection varies by pathogen or by multiple infections. Using hospital-based surveillance in children, we investigate the range of clinical severity for patients singly, multiply, and not infected with a group of commonly circulating viruses in Nha Trang, Vietnam. RT-PCR was performed to detect 13 respiratory viruses in nasopharyngeal samples from enrolled patients. We apply a novel clinical severity score and examine associations with the odds of being severe and differences in raw severity scores. We find no difference in severity between 0-, 1-, and 2-concurrent infections and little differences in severity between specific viruses. We find RSV and HMPV infections to be associated with 2- and 1.5-fold increase in odds of being severe, respectively, and that infection with ADV is consistently associated with lower risk of severity. Clinically, based on the results here, if RSV or HMPV virus is suspected, PCR testing for confirmatory diagnosis and for detection of multiple coinfecting viruses would be fruitful to assess whether a patient’s disease course is going to be severe.

Download Full-text

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

10.21203/rs.3.rs-24668/v1 ◽

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.

Download Full-text

Reactive T Cells in Convalescent COVID-19 Patients With Negative SARS-CoV-2 Antibody Serology

Frontiers in Immunology ◽

10.3389/fimmu.2021.687449 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sophie Steiner ◽

Tatjana Schwarz ◽

Victor M. Corman ◽

Franziska Sotzny ◽

Sandra Bauer ◽

...

Keyword(s):

Flow Cytometry ◽

T Cells ◽

T Cell Response ◽

Healthy Controls ◽

Disease Course ◽

Rt Pcr ◽

Viral Control ◽

Specific Antibodies ◽

Mild Disease

Despite RT-PCR confirmed COVID-19, specific antibodies to SARS-CoV-2 spike are undetectable in serum in approximately 10% of convalescent patients after mild disease course. This raises the question of induction and persistence of SARS-CoV-2-reactive T cells in these convalescent individuals. Using flow cytometry, we assessed specific SARS-CoV-2 and human endemic coronaviruses (HCoV-229E, -OC43) reactive T cells after stimulation with spike and nucleocapsid peptide pools and analyzed cytokine polyfunctionality (IFNγ, TNFα, and IL-2) in seropositive and seronegative convalescent COVID-19 patients as well as in unexposed healthy controls. Stimulation with SARS-CoV-2 spike and nucleocapsid (NCAP) as well as HCoV spike peptide pools elicited a similar T cell response in seropositive and seronegative post COVID-19 patients. Significantly higher frequencies of polyfunctional cytokine nucleocapsid reactive CD4+ T cells (triple positive for IFNγ, TNFα, and IL-2) were observed in both, seropositive (p = 0.008) and seronegative (p = 0.04), COVID-19 convalescent compared to healthy controls and were detectable up to day 162 post RT-PCR positivity in seronegative convalescents. Our data indicate an important role of NCAP-specific T cells for viral control.

Download Full-text

Association of olfactory dysfunction with hospitalization for COVID-19: a multicenter study in Kurdistan

10.1101/2020.07.26.20158550 ◽

2020 ◽

Author(s):

Hosna Zobairy ◽

Erfan Shamsoddin ◽

Mohammad Aziz Rasouli ◽

Nasrollah Veisi Khodlan ◽

Ghobad Moradi ◽

...

Keyword(s):

Outpatient Care ◽

Odds Ratio ◽

Patient Characteristics ◽

Olfactory Dysfunction ◽

Disease Course ◽

Shortness Of Breath ◽

Rt Pcr ◽

Point Scale ◽

Time Of Presentation ◽

Study Setting

Objective: To evaluate the association of olfactory dysfunction (OD) with hospitalization for COVID-19. Study Design: Multi-center cohort study. Setting: Emergency departments of thirteen COVID-19-designed hospitals in Kurdistan province, Iran. Subjects and Methods: Patients presenting with flu-like symptoms who tested positive by RT-PCR for COVID-19 between May 1st and 31st, 2020. At the time of presentation and enrollment, patients were asked about the presence of OD, fever, cough, shortness of breath, headache, rhinorrhea and sore throat. The severity of OD was assessed on an 11-point scale from 0 (none) to 10 (anosmia). Patients were either hospitalized or sent home for outpatient care based on standardized criteria. Results: Of 203 patients, who presented at a mean of 6 days into the COVID-19 disease course, 25 patients (12.3%) had new OD and 138 patients (68.0%) were admitted for their COVID-19. Patients admitted for COVID-19 had a higher prevalence of all symptoms assessed, including OD (p<0.05 in all cases), and OD identified admitted patients with 84.0% sensitivity and 34.3% specificity. On univariate logistic regression, hospitalization was associated with OD (odds ratio [OR] = 2.47, 95%CI: 1.085-6.911, p=0.049). However, hospitalization for COVID-19 was not associated with OD (OR=3.22, 95% CI: 0.57-18.31, p=0.188) after controlling for confounding demographics and comorbidities. Conclusion: OD may be associated with hospitalization for (and therefore more severe) COVID-19. However, this association between OD and COVID-19 severity is more likely driven by patient characteristics linked to OD, such as greater numbers of COVID-19 symptoms experienced or high-risk comorbidities.

Download Full-text

The SARS-CoV-2 RNA with mild pulmonary consolidation lasts longer in non-severe COVID-19 patients: an observational study

10.21203/rs.3.rs-43643/v2 ◽

2020 ◽

Author(s):

Chi Zhang ◽

Jiawen Li ◽

Jing Mu ◽

Daitao Zhang ◽

He Wang ◽

...

Keyword(s):

Clinical Information ◽

Disease Course ◽

Viral Dynamics ◽

Rt Pcr ◽

Igg Antibody ◽

Dynamic Changes ◽

Pulmonary Consolidation ◽

Lung Consolidation ◽

Almost All

Abstract Background: Since December 2019, COVID-19 has rapidly swept the world. It is particularly important to understand the dynamic changes of the whole disease course of non-severe patients from the onset to the follow-up after discharge.Methods: On February 1, 2020, 18 cases of non-severe COVID-19 appeared in a hospital in Beijing. All patients were SARS-CoV-2 RNA positive by RT-PCR for pharyngeal swabs. We recorded the clinical information and viral dynamics of these patients from the onset of the disease to 2 months after discharge. According to the severity of lung consolidation, 18 patients were divided into two groups (mild pulmonary consolidation group [imaging score ≤10]; severe pulmonary consolidation group [imaging score >10]).Results: Eighteen patients (median age 43) were included, including 14 females. Fever (11/18) and cough (8/18) were the most common symptoms. The duration of SARS-CoV-2 RNA positive in mild pulmonary consolidation group was significantly longer than severe pulmonary consolidation group (the median time was 30 days and 13 days, respectively, P= 0.0031). Two months after discharge, almost all patients were followed up for IgM antibody disappearance and IgG antibody production.Conclusion: In non-severe COVID-19 patients, the positive duration of the SARS-CoV-2 RNA in patients with mild pulmonary consolidation was longer than the severe pulmonary consolidation. However, it is necessary for a large sample to verify our conclusions.

Download Full-text