Differences in Clinical Characteristics Between Delta Variant and Wild-Type SARS-CoV-2 Infected Patients

Background: As delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevailed in the current coronavirus disease 2019 (COVID-19) pandemic, its clinical characteristics with the difference from those of wild-type strains have been little studied.Methods: We reported one cohort of 341 wild-type patients with COVID-19 admitted at Wuhan, China in 2020 and the other cohort of 336 delta variant patients with COVID-19 admitted at Yangzhou, China in 2021, with comparisons of their demographic information, medical history, clinical manifestation, and hematological data. Furthermore, within the delta variant cohort, patients with none, partial, and full vaccination were also compared to assess vaccine effectiveness.Findings: For a total of 677 patients with COVID-19 included in this study, their median age was 53.0 years [interquartile range (IQR): 38.0–66.0] and 46.8% were men. No difference was found in age, gender, and percentage of patients with the leading comorbidity between wild-type and delta variant cohorts, but delta variant cohort showed a lessened time interval between disease onset to hospitalization, a reduced portion of patients with smoking history, and a lowered frequency of clinical symptoms. For hematological parameters, most values demonstrated significant differences between wild-type and delta variant cohorts, while full vaccination rather than partial vaccination alleviated the disease condition. This reflected the viremic effect of delta variant when vaccination succeeds or fails to protect.Interpretation: Delta variant of SARS-CoV-2 may cause severe disease profiles, but timely diagnosis and full vaccination could protect patients with COVID-19 from worsened disease progression.

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Comparison of the Clinical Characteristics of Patients With COVID-19 in Suining and Wuhan

10.21203/rs.3.rs-32683/v1 ◽

2020 ◽

Author(s):

Xiao-juan Wu ◽

Chao-Ping Wang ◽

Xiao-Bin Luo ◽

Gao-Yan He ◽

Bao-Lin Jia ◽

...

Keyword(s):

Blood Glucose ◽

Incidence Rate ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Average Length ◽

Severe Disease ◽

Imaging Features ◽

Lung Consolidation ◽

Laboratory Test Results ◽

D Dimer

Abstract Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified in December 2019 in Wuhan. This study mainly analyzed the clinical characteristics, imaging features, and prognosis of patients with COVID-19 in Suining, one of China's fourth-tier cities, and Wuhan in 2019 and compared data between the 2 cities. Methods A retrospective analysis of the epidemiological history, clinical data, symptom presentation, laboratory test results, chest computed tomography (CT) imaging features, treatment measures and prognosis of 68 patients with COVID-19 diagnosed at Wuhan Red Cross Hospital and 17 patients with COVID-19 diagnosed at Suining Central Hospital from January 23, 2020, to February 27, 2020, was conducted. Results 1) The incidence rate of COVID-19 in Wuhan was 52.99‱, and the incidence rate in Suining was 0.04‱. The median age of patients with COVID-19 was 40.71 years old in Suining and 56.04 years old in Wuhan. The age of patients with COVID-19 in Wuhan was significantly older than that of patients with COVID-19 in Suining. Among the 68 patients with COVID-19 in Wuhan, 30 (44.1%) had hypertension, and 25 (36.8%) had diabetes. Three out of the 17 patients in Suining (17.6%) had hypertension, and 2 patients (11.8%) had diabetes. The proportion of patients with diabetes or hypertension in Wuhan was significantly higher than that in Suining (P<0.05). In the clinical classification, there were 1 (5.9%) and 23 (33.8%) patients with severe COVID-19 in Suining and Wuhan, respectively. The proportion of patients with severe COVID-19 in Wuhan was significantly higher than that in Suining (P<0.05).Fever and cough were the most common clinical symptoms, with 9 cases (52.9%) and 8 cases (47.1%) in Suining, respectively, and 54 cases (79.4%) and 42 cases (61.8%) in Wuhan, respectively. There was 1 patient (5.9%) with COVID-19 with dyspnea in Suining and 23 patients (33.8%) with COVID-19 with dyspnea in Wuhan; the difference was statistically significant (P<0.05). Chest CT showed that lung consolidation occurred in 2 (11.8%) and 26 (38.2%) patients with COVID-19 in Suining and Wuhan, respectively. The proportion of lung consolidation in patients in Wuhan was significantly higher than that in patients in Suining (P<0.05). The laboratory tests suggested that percentage ofelevated C-reactive protein (CRP) (58.8%), ALT (33.8%), blood glucose (45.6%), creatine kinase (CK) (33.8%) or D-dimer (47.1%) of patients in Wuhan were significantly increased than those in Suining (29.4%, 5.9%, 17.6%, 5.9%, and 17.7%, respectively). Moreover, the average length of hospital stay of patients in Wuhan was 17.49 days, which was significantly longer than that of patients in Suining (12.29 days). Conclusions The incidence of COVID-19 in fourth-tier cities, Suining, in China was significantly lower than that in Wuhan, and the disease severity was generally lower than that in Wuhan, with mostly good prognoses. Advanced age, diabetes, and hypertension are important factors that aggravate COVID-19, while elevated CRP, ALT, blood glucose, CK, and D-dimer levels are important indicators for severe disease.

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Heterogeneity analysis of COVID - 19 clinical phenotype in Wuhan

10.21203/rs.3.rs-35572/v1 ◽

2020 ◽

Author(s):

Qin Yin ◽

Jiao Xie ◽

Jixian Zhang ◽

Zhen Fu ◽

Wangcai Zhu ◽

...

Keyword(s):

Respiratory Symptoms ◽

Clinical Characteristics ◽

Muscle Soreness ◽

Clinical Symptoms ◽

Group A ◽

Missed Diagnosis ◽

The Difference ◽

Group B ◽

Loss Of Appetite ◽

Group D

Abstract BackgroundSince the outbreak of coronavirus disease 2019 (COVID-19), some studies reported the clinical characteristics of COVID-19 patients in hospital. However, these studies did not investigate the clinical symptoms heterogeneity of COVID-19 patients in the outpatient. This study aimed to describe the heterogeneity of clinical characteristics of outpatient COVID-19 patients.MethodsCOVID-19 patients visiting the respiratory outpatient department of our hospital from January 1st to February 28st 2020 were retrospectively analyzed. Based on the complaints, the patients were classified into four groups including group A (patients without symptoms), group B (patients with fever), group C (patients with respiratory symptoms but without fever), and group D (patients with extra-respiratory symptoms but without fever). The difference of clinical characteristics, basic diseases, laboratory examination of outpatient, characteristics of chest CT imaging among all the groups were analyzed and compared.ResultsA total of 309 COVID-19 patients were included with 126 men and 183 women. The common symptoms included fatigue (59.87%, 95% CI: 54.17-65.38%), loss of appetite (51.13%, 95% CI: 45.41-56.83%), fever (50.81%, 95% CI: 45.09-56.51%), muscle soreness (41.42%, 95% CI:35.88-47.14%), and dry cough (35.28%, 95% CI:29.95-40.89%). The percentages of group A to group D were 2.91%, 50.81%, 18.12%, and 28.16%, respectively. The most common symptoms in Group D included fatigue, loss of appetite, muscle soreness. ConclusionThe heterogeneity of clinical symptoms for COVID-19 patients in the outpatient is significant. We should pay attention to patients without symptoms or those with only extra-respiratory symptoms, who are prone to missed diagnosis.

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Mast Cells Are Essential for Early Onset and Severe Disease in a Murine Model of Multiple Sclerosis

Journal of Experimental Medicine ◽

10.1084/jem.191.5.813 ◽

2000 ◽

Vol 191 (5) ◽

pp. 813-822 ◽

Cited By ~ 335

Author(s):

Virginia H. Secor ◽

W. Evan Secor ◽

Claire-Anne Gutekunst ◽

Melissa A. Brown

Keyword(s):

Multiple Sclerosis ◽

Mast Cell ◽

Mast Cells ◽

B Cell ◽

Disease Incidence ◽

Severe Disease ◽

Disease Onset ◽

Allergic Inflammation ◽

Indirect Evidence ◽

Wild Type

In addition to their well characterized role in allergic inflammation, recent data confirm that mast cells play a more extensive role in a variety of immune responses. However, their contribution to autoimmune and neurologic disease processes has not been investigated. Experimental allergic encephalomyelitis (EAE) and its human disease counterpart, multiple sclerosis, are considered to be CD4+ T cell–mediated autoimmune diseases affecting the central nervous system. Several lines of indirect evidence suggest that mast cells could also play a role in the pathogenesis of both the human and murine disease. Using a myelin oligodendrocyte glycoprotein (MOG)-induced model of acute EAE, we show that mast cell–deficient W/Wv mice exhibit significantly reduced disease incidence, delayed disease onset, and decreased mean clinical scores when compared with their wild-type congenic littermates. No differences were observed in MOG-specific T and B cell responses between the two groups, indicating that a global T or B cell defect is not present in W/Wv animals. Reconstitution of the mast cell population in W/Wv mice restores induction of early and severe disease to wild-type levels, suggesting that mast cells are critical for the full manifestation of disease. These data provide a new mechanism for immune destruction in EAE and indicate that mast cells play a broader role in neurologic inflammation.

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Differential effects of treatment with a small-molecule VLA-4 antagonist before and after onset of relapsing EAE

Blood ◽

10.1182/blood-2003-03-0974 ◽

2003 ◽

Vol 102 (13) ◽

pp. 4464-4471 ◽

Cited By ~ 46

Author(s):

Bradley E. Theien ◽

Carol L. Vanderlugt ◽

Cheryl Nickerson-Nutter ◽

Mark Cornebise ◽

Daniel M. Scott ◽

...

Keyword(s):

T Cells ◽

Small Molecule ◽

Clinical Symptoms ◽

Severe Disease ◽

Disease Onset ◽

Proteolipid Protein ◽

Clinical Disease ◽

Disease Remission ◽

Before And After ◽

Late Antigen

AbstractInteraction of very late antigen-4 (VLA-4) with its ligand vascular cell adhesion molecule-1 (VCAM-1) is required for central nervous system (CNS) migration of encephalitogenic T cells in relapsing experimental autoimmune encephalomyelitis (R-EAE). Anti-VLA-4 monoclonal antibody (mAb) treatment prior to EAE onset inhibits disease induction; however, treatment initiated after the appearance of clinical symptoms increases relapse rates, augments Th1 responses, and enhances epitope spreading perhaps due to the activation of costimulatory signals. To negate the potential costimulatory activity of intact anti-VLA-4, we examined the ability of BIO 5192, a small-molecule VLA-4 antagonist, to regulate active proteolipid protein 139-151 (PLP139-151)-induced R-EAE. BIO 5192 administered one week after peptide priming (ie, before clinical disease onset) delayed the clinical disease onset but led to severe disease exacerbation upon treatment removal. BIO 5192 treatment initiated during disease remission moderately enhanced clinical disease while mice were on treatment and also resulted in posttreatment exacerbation. Interestingly, BIO 5192 treatment begun at the peak of acute disease accelerated entrance into disease remission and inhibited relapses, but treatment removal again exacerbated disease. Enhanced disease was caused by the release of encephalitogenic cells from the periphery and the rapid accumulation of T cells in the CNS. Collectively, these results further demonstrate the complexity of VLA-4/VCAM interactions, particularly in a relapsing-remitting autoimmune disease. (Blood. 2003;102:4464-4471)

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Socio-clinical characteristics of COVID-19 disease in Anbar Governorate, Iraq

Journal of Emergency Medicine Trauma and Acute Care ◽

10.5339/jemtac.2021.8 ◽

2021 ◽

Vol 2021 (1) ◽

Author(s):

Hazim Ghazzay ◽

Raid M. Al-Ani ◽

Mothana A. Khalil ◽

Ahmed Faeq Hammad

Keyword(s):

Mortality Rate ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Smoking Status ◽

The Body ◽

Smoking History ◽

Systemic Diseases ◽

Wide Range ◽

Significant Difference ◽

History Of

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact worldwide. Clinical symptoms vary in different countries. In addition, a wide range of symptoms involve most of the body systems including the respiratory system. However, COVID-19 has no classical presenting signs. Objective: This study aimed to describe the sociodemographic and clinical characteristics of hospitalized and nonhospitalized COVID-19 patients in Anbar Governorate, Iraq. Patients and Methods: This retrospective study was conducted in Anbar Governorate, Iraq. The study covered the period from May 1 to June 30, 2020. All cases were confirmed by real-time polymerase chain reaction. Data concerning the age, gender, residence, occupation, clinical symptoms, smoking, history of systemic diseases, and disease fate were collected from patients’ records. Results: Of 481 patients, 259 (53.8%) were male. The patient age ranged from 12 to 104 years with a mean age of 45.7 ± 16.11. Majority of the patients aged 36–58 years (n = 204, 42.4%) and were urban dwellers (n = 318, 66.1%), non-healthcare workers (n = 447, 92.9%), and nonsmokers (n = 440, 91.5%). The chief complaint was fever (n = 300, 64.2%). The mortality rate was 5.6% (n = 27). The increasing age, male gender, and a history of systemic illnesses showed an increased effect on the mortality rate (p < 0.05). Residence, occupation, and smoking status did not show significant difference (p>0.05). Conclusion: The mortality rate was 5.6%. Fever was the main feature of COVID-19. Male, older individuals with systemic diseases showed higher mortality rate.

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Clinical Characteristics of Patients with SARS-CoV-2 N501Y Variants in General Practitioner Clinic in Japan

Journal of Clinical Medicine ◽

10.3390/jcm10245865 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5865

Author(s):

Mariko Hanafusa ◽

Jin Kuramochi ◽

Katsutoshi Ishihara ◽

Makiko Honda ◽

Nobutoshi Nawa ◽

...

Keyword(s):

General Practitioner ◽

Odds Ratio ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Wild Type ◽

Radiological Findings ◽

Significant Difference ◽

In The Wild ◽

The Mean

The clinical characteristics of patients with N501Y mutation in SARS-CoV-2 variants (N501YV) is not fully understood, especially in the setting of general practice. In this retrospective cohort study, COVID-19 patients admitted to one general practitioner clinic between 26 March and 26 May 2021 were retrospectively analyzed. The characteristics, clinical symptoms and radiological findings before treatment were compared between N501YV and wild-type 501N. Twenty-eight patients were classified as wild-type 501N and 24 as N501YV. The mean (±standard deviation) age was 37.4 (±16.1) years, with no significant difference between groups. Among clinical symptoms, prevalence of fever of 38 degrees Celsius (°C) or higher was significantly higher in the N501YV group than in the wild-type 501N group (p = 0.001). Multivariate analysis showed that fever of 38 °C or higher remained significantly associated with N501YV (adjust odds ratio [aOR]: 6.07, 95% confidence interval [CI]: 1.68 to 21.94). For radiological findings, the lung involvement area was significantly larger in patients infected with N501YV (p = 0.013). In conclusion, in the N501YV group, fever of 38 °C or higher and extensive pneumonia were more frequently observed compared to the wild-type 501N group. There was no significant difference in terms of other demographics and clinical symptoms.

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The dynamic antibody responses on COVID-19 patients with different severity: A retrospective research

10.21203/rs.3.rs-60563/v1 ◽

2020 ◽

Author(s):

Wanrong Lu ◽

Ping Wu ◽

Liang He ◽

Yifan Meng ◽

Peng Wu ◽

...

Keyword(s):

Regression Models ◽

Severe Disease ◽

Disease Onset ◽

Antibody Responses ◽

Clinical Severity ◽

Serum Samples ◽

Logistic Regression Models ◽

The Difference ◽

Igg Level

Abstract ObjectivesWe aimed to explore the association between dynamic antibody responses and the clinical severity of COVID-19. MethodsWe collected complete follow-up data of 777 pathogen-confirmed COVID-19 patients with corresponding IgG/IgM testing results. ResultsWe found the overall positive rates of IgG and IgM in severe patients were slightly higher than those in non-severe patients. In addition, higher IgG levels were detected in severe patients compared with non-severe patients (P=0.026). Through further analysis, our results showed that the statistical difference in the IgG only significant in serum samples taken ≤14 days from disease onset (P<0.001). In 74 patients who taken detection more than three times, by analyzing the antibody expression levels at different time points, we found that the difference between IgG was more obvious than that of IgM among severe/non-severe patients. In multivariate logistic regression models, after adjusting for cofactors, the higher anti-SARS-CoV-2 IgG level before 14 days from disease onset was independently associated with severe disease in COVID-19 (OR=1.310, 95%CI= 1.137-1.509).ConclusionWe observed differences in antibody responses among COVID-19 patients with different disease severity. A high IgG level in the first 14 days from disease onset might positively associate with severe disease.

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Clinical Characteristics and Outcome of Neuronal Surface Antibody-Mediated Autoimmune Encephalitis Patients in a National Cohort

Frontiers in Neurology ◽

10.3389/fneur.2021.611597 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zsófia Hayden ◽

Beáta Bóné ◽

Gergely Orsi ◽

Monika Szots ◽

Ferenc Nagy ◽

...

Keyword(s):

Clinical Characteristics ◽

Clinical Symptoms ◽

Psychiatric Symptoms ◽

Brain Mri ◽

Disease Onset ◽

Neuronal Cell ◽

Autoimmune Encephalitis ◽

Ovarian Teratoma ◽

Test Results ◽

Nmdar Encephalitis

Background: In our previous single-center study of autoimmune encephalitis (AE) related autoantibody test results we found positivity in 60 patients out of 1,034 with suspected AE from 2012 through 2018 as part of a Hungarian nationwide program. In our current multicenter retrospective study, we analyzed the clinical characteristics and outcome of AE patients with positive neuronal cell surface autoantibody test results.Methods: A standard online questionnaire was used to collect demographic and clinical characteristics, laboratory and imaging data, therapy and prognosis of 30 definitive AE patients in four major clinical centers of the region.Results: In our study, 19 patients were positive for anti-NMDAR (63%), 6 patients (20%) for anti-LGI1, 3 patients for anti-GABABR (10%) and 3 patients for anti-Caspr2 (10%) autoantibodies. Most common prodromal symptoms were fever or flu-like symptoms (10/30, 33%). Main clinical features included psychiatric symptoms (83%), epileptic seizures (73%) and memory loss (50%). 19 patients (63%) presented with signs of central nervous system (CNS) inflammation, which occurred more frequently in elder individuals (p = 0.024), although no significant differences were observed in sex, tumor association, time to diagnosis, prognosis and immunotherapy compared to AE patients without CNS inflammatory markers. Anti-NMDAR encephalitis patients were in more severe condition at the disease onset (p = 0.028), although no significant correlation between mRS score, age, sex and immunotherapy was found. 27% of patients (n = 8) with associated tumors had worse outcome (p = 0.045) than patients without tumor. In most cases, immunotherapy led to clinical improvement of AE patients (80%) who achieved a good outcome (mRS ≤ 2; median follow-up 33 months).Conclusion: Our study confirms previous publications describing characteristics of AE patients, however, differences were observed in anti-NMDAR encephalitis that showed no association with ovarian teratoma and occurred more frequently among young males. One-third of AE patients lacked signs of inflammation in both CSF and brain MRI, which emphasizes the importance of clinical symptoms and autoantibody testing in diagnostic workflow for early introduction of immunotherapy, which can lead to favorable outcome in AE patients.

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Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs

Multiple Sclerosis Journal ◽

10.1177/1352458512463764 ◽

2012 ◽

Vol 19 (6) ◽

pp. 765-774 ◽

Cited By ~ 41

Author(s):

H Tedeholm ◽

J Lycke ◽

B Skoog ◽

V Lisovskaja ◽

J Hillert ◽

...

Keyword(s):

First Generation ◽

Cox Regression ◽

Disease Onset ◽

Population Based ◽

Time Interval ◽

Period Effect ◽

Disease Modifying Drugs ◽

Cox Regression Analysis ◽

Immunomodulating Therapy ◽

The Difference

Background: It is currently unknown whether early immunomodulatory treatment in relapsing–remitting MS (RRMS) can delay the transition to secondary progression (SP). Objective: To compare the time interval from onset to SP in patients with RRMS between a contemporary cohort, treated with first generation disease modifying drugs (DMDs), and a historical control cohort. Methods: We included a cohort of contemporary RRMS patients treated with DMDs, obtained from the Swedish National MS Registry (disease onset between 1995–2004, n = 730) and a historical population-based incidence cohort (onset 1950–64, n = 186). We retrospectively analyzed the difference in time to SP, termed the “period effect” within a 12-year survival analysis, using Kaplan-Meier and Cox regression analysis. Results: We found that the “period” affected the entire severity spectrum. After adjusting for onset features, which were weaker in the contemporary material, as well as the therapy initiation time, the DMD-treated patients still exhibited a longer time to SP than the controls (hazard ratios: men, 0.32; women, 0.53). Conclusion: Our results showed there was a longer time to SP in the contemporary subjects given DMD. Our analyses suggested that this effect was not solely driven by the inclusion of benign cases, and it was at least partly due to the long-term immunomodulating therapy given.

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Socio-clinical Characteristics of COVID-19 Pandemic in Anbar Governorate, Iraq

10.21203/rs.3.rs-582868/v1 ◽

2021 ◽

Author(s):

Hazim Ghazzay ◽

Raid M. Al-Ani ◽

Mothana A. Khalil ◽

Ahmed Faeq Hammad

Keyword(s):

Mortality Rate ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

The Body ◽

Smoking History ◽

P Value ◽

Systemic Diseases ◽

Wide Range ◽

Significant Difference ◽

History Of

Abstract Background: The pandemic COVID-19 disease has a massive impact on the whole world. There is a variation in clinical symptoms in different countries. In addition, there is a wide range of symptoms that involve most of the systems in the body including the respiratory system. However, there is no classical presentation of this devastating disease.Objective: To describe the socio-demographic and clinical characteristics of hospitalized and non-hospitalized patients with confirmed COVID-19 infection in Anbar Governorate, Iraq.Patients and Methods: This retrospective study was conducted in Anbar Governorate, Iraq. The study covered the period from 1st of May to 30th of June 2020. All cases were confirmed by Real-time polymerase chain reaction. Data concerning the age, gender, residence, occupation, clinical symptoms, smoking, history of systemic diseases, and the fate of the disease were collected from patients’ records. Results: Out of 481 patients, there were 259 males (53.8%). The age ranged from 12–104 years with a mean age of 45.7 ±16.11. The majority of the subjects were in the age group 36-58 years (n=204; 42.4%), urban (n=318; 66.1%), non-healthcare worker (n=447; 92.9%), and non-smoker (n=440; 91.5%). The main complaint was fever (n=300; 64.2%). The mortality rate was 5.6% (n=27). The increasing age, male gender, and patients with a history of systemic illnesses showed an increased impact on the death rate (P-value<0.05). While residence, occupation, and smoking didn't show a statistically significant difference (P-value>0.05).Conclusion: The fatality rate was 5.6%. Fever was the main feature of the COVID-19 infection. The elderly, males, and individuals with systemic diseases showed higher mortality rate.

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