scholarly journals Familial aggregation of COVID-19 severity suggests a genetic component to host infection response

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Alexandre R Vieira ◽  
Keyword(s):  
Familial Aggregation ◽  
Severe Disease ◽  
Case Series ◽  
Genetic Component ◽  
Mild Disease ◽  
Individual Host ◽  
Disease Pattern ◽  
Infection Response ◽  
Severity Of The Disease ◽  
Host Infection

Familial aggregation of COVID-19 cases suggest transmission occurs by contact but can also be evidence of a genetic component to the disease presentation. The goal of this work was to evaluate the disease pattern in families that many individuals have been affected by the disease. A case series analysis of six families that had many individuals affected by COVID-19 and the pattern of the severity of the disease is reported. Families were from two densely populated cities in Brazil. Participants included family members of six unrelated families, with some individuals that showed signs of COVID-19. The exposure was SARS-CoV-2 in the same household. The main outcomes and measures were disease affection and severity, including mortality. From the six families, two had mild cases only, whereas the other four families showed severe disease and death in the same sibship. The two families that had mild disease could be followed for six months and one showed reinfection after six months. This cases series suggest that disease severity aggregates in families, which suggests a genetic component for individual host response to SARS-CoV-2 infection.

A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments

2021 ◽  
Vol 60 (4-5) ◽  
pp. 247-251
Author(s):  
Ameer Hassoun ◽  
Nessy Dahan ◽  
Christopher Kelly
Keyword(s):  
New York ◽  
Case Reports ◽  
Severe Disease ◽  
Case Series ◽  
Pediatric Emergency ◽  
Rt Pcr ◽  
Vulnerable Group ◽  
Mild Disease ◽  
Young Infants ◽  
Novel Coronavirus

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.

scholarly journals Clinical asthma phenotypes in the real world: opportunities and challenges

Breathe ◽  
2015 ◽  
Vol 11 (3) ◽  
pp. 186-193 ◽  
Author(s):  
Clementine Bostantzoglou ◽  
Vicky Delimpoura ◽  
Konstantinos Samitas ◽  
Eleftherios Zervas ◽  
Frank Kanniess ◽  
...  
Keyword(s):  
Severe Disease ◽  
Asthma Management ◽  
Airflow Limitation ◽  
List Type ◽  
Asthma Treatment ◽  
Future Planning ◽  
Phenotypic Characteristics ◽  
Asthmatic Patients ◽  
Mild Disease ◽  
Severity Of The Disease

Key PointsAsthma is a heterogeneous syndrome ranging from mild disease with barely noticeable symptoms to very severe disease with constant symptoms that may greatly hinder patients’ quality of life.The aim of asthma treatment is control of asthma and the prevention of risk of exacerbations and fixed airflow limitation.Asthma management must be individualised; tailored not only to the severity of the disease but importantly, to the phenotypic characteristics of the patient and modified according to response to treatment.Educational AimsTo inform readers about the current understanding on the treatment of asthma.To highlight the usefulness of phenotypes in treating asthmatic patients, especially those with severe disease.To introduce the issues of severe asthma management and future planning.Asthma is a common, chronic and heterogeneous syndrome, affecting people of all ages, all races and both sexes. It may range from mild disease with barely noticeable symptoms, to very severe disease with constant symptoms that greatly hinder the life of the patient. Guidelines issued by various medical societies provide guidance on how to diagnose and manage asthmatic patients. It is now increasingly recognised that asthma management must be individualised, tailored not only to the severity of the disease but to the phenotypic characteristics of each patient. The aim of asthma treatment is control of asthma and the prevention of risk of exacerbations and fixed airflow limitation. Asthma control can be easily assessed clinically through simple screening tools such as the use of validated questionnaires and spirometry. The use of inflammatory biomarkers can be an alternative approach that, however, requires more time and resources. Asthma treatment involves the use of controllers, mainly inhaled corticosteroids and long-acting β2-agonists, and relievers, mainly rapid-acting β2-agonists. Controller medications reduce airway inflammation, lead to better symptom control and reduce the risk of future exacerbations. Reliever (rescue) medications alleviate symptoms and prevent exercise-induced bronchoconstriction. Treatment must be based on a “stepwise approach” in order to achieve good control of symptoms and to minimise future risks of exacerbations. That is, less treatment for mild disease, more treatment for severe, uncontrolled disease. Once good asthma control has been achieved and maintained, treatment should be stepped down. In severe asthmatics, phenotypic characterisation becomes more clinically useful and add-on treatment such as anti-immunoglobulin E monoclonal antibodies may be required. Despite our better understanding of asthma, there are still patients who will not respond to treatment and remain symptomatic. Dissemination of guidelines and national plans allowing early diagnosis of asthma as well as access to specialised primary and secondary care for asthmatic patients, personalised treatment and continuity of care may lead to excellence in care and controlled asthma for the majority of patients. Education of the patient in asthma is also very important, as in every chronic disease, as the patients live with the disease every day while they visit a healthcare professional a few times a year. Future planning for new treatments should focus on the needs of such severe asthma patients.

scholarly journals Early and Strong Antibody Responses to SARS-CoV-2 Predict Disease Severity in COVID-19 Patients

2022 ◽  
Author(s):  
Jānis Plūme ◽  
Artis Galvanovskis ◽  
Sindija Šmite ◽  
Nadezda Romanchikova ◽  
Pawel Zayakin ◽  
...  
Keyword(s):  
Cell Activation ◽  
Severe Disease ◽  
Prognostic Significance ◽  
Serum Levels ◽  
Epidemiological Studies ◽  
Antibody Responses ◽  
Mast Cell Activation ◽  
N Protein ◽  
Mild Disease ◽  
Severity Of The Disease

Abstract Background Antibody response to SARS-CoV-2 is a valuable biomarker for the assessment of the spread of the virus in a population and evaluation of the vaccine candidates. Recent data suggest that antibody levels also may have a prognostic significance in COVID-19. Most of the serological studies so far rely on testing antibodies against spike (S) or nucleocapsid (N) protein, however antibodies can be directed against other structural and nonstructural proteins of the virus, whereas their frequency, biological and clinical significance is unknown. Methods A novel antigen array comprising 30 SARS-CoV-2 antigens or their fragments was developed and used to examine IgG, IgA, IgE and IgM responses to SARS-CoV-2 in sera from 103 patients with COVID-19 including 34 patients for whom sequential samples were available, and 20 pre-pandemic healthy controls. Results Antibody responses to various antigens are highly correlated and the frequencies and peak levels of antibodies are higher in patients with severe/moderate disease than in those with mild disease. This finding supports the idea that antibodies against SARS-CoV-2 may exacerbate the severity of the disease via antibody-dependent enhancement. Moreover, early IgG and IgA responses to full length S protein may be used as an additional biomarker for the identification of patients who are at risk of developing severe disease. Importantly, this is the first study reporting that SARS-CoV-2 elicits IgE responses and their serum levels positively correlate with the severity of the disease thus suggesting a link between high levels of antibodies and mast cell activation. Conclusions This is the first study assessing the prevalence and dynamics IgG, IgA, IgE and IgM responses to multiple SARS-CoV-2 antigens simultaneously. Results provide important insights into the pathogenesis of COVID-19 and have implications in planning and interpreting antibody-based epidemiological studies.

scholarly journals Urinary viral shedding of COVID-19 and its clinical associations: A Systematic Review and Meta-analysis of Observational Studies

2020 ◽  
Author(s):  
Amir H Kashi ◽  
Jean de la Rosette ◽  
Erfan Amini ◽  
Hamidreza Abdi ◽  
Morteza Fallah-karkan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sample Size ◽  
Case Reports ◽  
Meta Analysis ◽  
Severe Disease ◽  
Disease Onset ◽  
Case Series ◽  
Adult Patients ◽  
Mild Disease ◽  
Viral Shedding

Objectives: To review the current literature on the presence of COVID-19 virus in the urine of infected patients and to explore the clinical features that can predict the presence of COVID-19 in urine. Materials and Methods: A systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infected patients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of >= 9. Results: Thirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of >= 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 - 2.87) in the metaanalysis. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID-19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding. Conclusions: While COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19 infected patients during medical interventions like endoscopy and urethral catheterization.

SARS-COV2 Virus in Tears and Conjunctival Secretions of COVID-19 Patients

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Ambreen Gull ◽  
M.Rafaaq Saleem ◽  
Fuad Ahmad Khan Niazi
Keyword(s):  
Severe Disease ◽  
Virus Transmission ◽  
Case Series ◽  
Polymerase Chain Reaction Analysis ◽  
High Viral Load ◽  
Viral Rna ◽  
Rt Pcr ◽  
Course Of Illness ◽  
Mild Disease ◽  
Therapeutic Services

Purpose:  To determine the presence of SARS-COV 2 viruses in tears and conjunctival secretions of patients with diagnosed COVID-19. Study Design:  Prospective interventional case series. Place and Duration of Study:  Rawalpindi Institute of Urology, Department of infectious diseases, Holy Family Hospital, Rawalpindi Medical University, from September 2020 to October 2020. Methods:  Samples of conjunctival and tear secretions were collected from 60 hospitalized patients of COVID-19 who were confirmed with nasopharyngeal swabs test. Disposable conjunctival swab sticks were used for sampling. Samples were taken within 3 days of admission. SARS-COV 2 virus evaluation in tears and conjunctival secretions was done by Qualitative RT-PCR (Reverse transcriptase polymerase chain reaction) analysis. Ocular features were documented. Regarding systemic course of illness, details were noted from their hospital records. Results:  Mean age of the patients was 56.63 ± 16.373 years. Out of 60 patients, 42 were males and 18 were females. Twenty two (36.6%) patients had mild disease and moderate and severe disease was present in 19 patients (31.6%) each. Six (10%) patients had positive conjunctival and tear secretions for SARS-COV 2 viral RNA. All patients with positive ocular secretions for viral RNA were in first week of course of disease and 3 patients had severe COVID 19 disease signifying high viral load.  Only one patient had conjunctivitis and ocular symptoms of redness and foreign body sensation. Conclusion:  There is likelihood of SARS-COV 2 virus transmission via ocular secretions as frequency of patients with SARS-COV 2 viral RNA detected in tears was 10% in current study therapeutic services. Key Words:  SARS-COV 2 Virus, COVID 19, Conjunctivitis, Qualitative RT-PCR, Ocular Manifestations

scholarly journals Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

2020 ◽  
Vol 179 (8) ◽  
pp. 1315-1323 ◽  
Author(s):  
Niccolò Parri ◽  
◽  
Anna Maria Magistà ◽  
Federico Marchetti ◽  
Barbara Cantoni ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Disease ◽  
Case Series ◽  
High Rate ◽  
Respiratory Support ◽  
Hospital Level ◽  
Mild Disease ◽  
Moderate Disease ◽  
Increased Risk

Abstract Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered. Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known:• There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New:• Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease.• However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.

scholarly journals Bordetella pertussis surveillance in England and Wales: 1995–7

1999 ◽  
Vol 123 (3) ◽  
pp. 403-411 ◽  
Author(s):  
P. G. VAN BUYNDER ◽  
D. OWEN ◽  
J. E. VURDIEN ◽  
N. J. ANDREWS ◽  
R. C. MATTHEWS ◽  
...  
Keyword(s):  
Bordetella Pertussis ◽  
Hospital Admissions ◽  
Severe Disease ◽  
Disease Onset ◽  
Booster Vaccination ◽  
Late Summer ◽  
Background Rate ◽  
England And Wales ◽  
Mild Disease ◽  
Severity Of The Disease

Available data sources on disease due to Bordetella pertussis, including notifications, hospital admissions, deaths, and an enhanced laboratory-based surveillance system commenced in January 1994, were reviewed for the period 1995–7. Pertussis notifications continued their approximately 3-year cycle although at historically reduced levels. A slight seasonal increase in late summer/early autumn existed over and above a relatively constant background rate. Over time, the proportion of pertussis cases in younger, unvaccinated children, and to a lesser extent, adolescents and young adults, is increasing. There is a continuing significant and under- reported mortality associated with pertussis in the very young age group. Disease due to serotype 1,2 is on the increase despite persistent high vaccination levels and this serotype causes more severe disease. The provision of preventative antibiotics prior to disease onset reduced the severity of the disease but its use remains uncommon in England and Wales. While overall levels of pertussis notifications have declined in recent times, vaccination efficacy wanes with increasing age, and pertussis remains a significant cause of mortality and severe morbidity in the very young. This could be reduced by timely booster vaccination and increased recognition of mild disease in older cases followed by early antibiotic therapy for the very young household contacts.

scholarly journals A case series of children and young people admitted to a tertiary care hospital in Germany with COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonathan Remppis ◽  
Tina Ganzenmueller ◽  
Malte Kohns Vasconcelos ◽  
Oliver Heinzel ◽  
Rupert Handgretinger ◽  
...  
Keyword(s):  
Severe Disease ◽  
Tertiary Care ◽  
Fatal Outcome ◽  
Case Series ◽  
Respiratory Illness ◽  
Care Hospital ◽  
Course Of Disease ◽  
Mild Disease ◽  
Underlying Diseases ◽  
Inflammatory Syndrome

Abstract Background While our knowledge about COVID-19 in adults has rapidly increased, data on the course of disease and outcome in children with different comorbidities is still limited. Methods Prospective, observational study at a tertiary care children’s hospital in southern Germany. Clinical and virology data from all paediatric patients admitted with SARS-CoV-2 infection at our hospital were prospectively assessed. Results Between March and November 2020, 14 patients were admitted with COVID-19. One patient was admitted a second time with COVID-19 6 months after initial disease. Among seven patients with severe underlying comorbidities, three developed multisystem inflammatory syndrome (MIS-C), two were admitted to the paediatric intensive care unit. One patient needed invasive ventilation. Another patient died shortly after discharge of COVID-19-related complications. Conclusions While COVID-19 generally causes mild disease in children, severe respiratory illness and MIS-C occur, in some cases with fatal outcome. Children with underlying diseases might be at special risk for severe disease.

scholarly journals SAT0541 THE SEVERITY OF FMF MAY BE ASSOCIATED WITH CO-MORBIDITIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.3-1228
Author(s):  
M. E. Tezcan ◽  
N. Şen ◽  
M. Yilmaz ◽  
Ö. Volkan ◽  
E. Tükel ◽  
...  
Keyword(s):  
Familial Mediterranean Fever ◽  
Scoring System ◽  
Disease Duration ◽  
Severe Disease ◽  
Smoking History ◽  
Disease Group ◽  
Severity Scoring ◽  
Mild Disease ◽  
Co Morbidity ◽  
Mediterranean Fever

Background:Familial Mediterranean fever (FMF) is an auto inflammatory disease with recurrent attacks of serositis. Frequent attacks and disease related sequels may be associated with co-morbidities in FMF patients.Objectives:One of the tools for evaluating the FMF severity is the international severity scoring system for FMF (ISSF)1. This score includes disease related sequels, acute phase measurements, attack features and exertional leg pain. Therefore, more severe disease may be link with subclinical inflammation, amyloidosis and frequent, prolonged and widespread attacks. All these components may augment the frequency of non-disease related co-morbidities.Methods:We enrolled 158 FMF patients who fulfilled modifiedTel-HashomerDiagnosisCriteria2. The patients dichotomized based upon disease severity (mild disease or severe disease). Patients with ISSF scores lower or equal to 2 were accepted to have mild disease. Then, we compared frequency of non-disease related co-morbidities between the groups. These co-morbidities arehypertension, hypothyroidism, hyperthyroidism cardiovascular diseases, coronary artery diseases, cerebrovascular diseases, chronic renal disease (non-FMF related), chronic obstructive pulmonary diseases, and diabetes mellitus. This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. All the patients gave written informed consent. P-value lower than 0.05 was considered as statistically significant.Results:Demographic features, disease duration, smoking history and body mass index (BMI) were similar between the groups. Frequency of co-morbidity in severe disease group was statistically higher than mild disease group (p=0.02). Most frequent co-morbidity was hypertension in both groups.Table.Features of mild and severe FMF groupsMild (n=135)Severe (n=23)pGender (M/F)47/8811/120.23Age36.4±11.336.5±14.30.68Smoking (%)38 (28.1)5 (21.7)0.52BMI (kg/m2)24.3±9.224.0±8.90.34Disease duration (year)7.7±11.38.6±14.30.09Amyloidosis (%)2 (1.4)3 (13.0)0.02Exon 10 homozygote (%)35 (25.9)9 (39.1)0.19Colchicine dosage (mg/day)1.2±0.41.4±0.50.02ISSF scores0.7 ±0.73.4±0.5<0.001Co-morbidity (%)25 (18.5)9 (39.1)0.02Conclusion:In our FMF patient cohort, we found that severity of the disease may be associated with higher frequency of co-morbidities. Therefore, clinicians should be aware of the high possibility of co-morbidities in patients with more severe FMF and addressed these co-morbidities timely and properly.References:[1]Demirkaya E, et al. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016;75:1051-6.[2]Berkun Y, et al. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.Acknowledgments:NoneDisclosure of Interests:None declared

scholarly journals SARS-CoV-2-Laden Respiratory Aerosol Deposition in the Lung Alveolar-Interstitial Region Is a Potential Risk Factor for Severe Disease: A Modeling Study

2021 ◽  
Vol 11 (5) ◽  
pp. 431
Author(s):  
Sabine Hofer ◽  
Norbert Hofstätter ◽  
Albert Duschl ◽  
Martin Himly
Keyword(s):  
Risk Factor ◽  
Particle Deposition ◽  
Early Stage ◽  
Severe Disease ◽  
Ambient Air ◽  
Aerosol Deposition ◽  
Pulmonary Involvement ◽  
Mild Disease ◽  
Disease Initiation

COVID-19, predominantly a mild disease, is associated with more severe clinical manifestation upon pulmonary involvement. Virion-laden aerosols and droplets target different anatomical sites for deposition. Compared to droplets, aerosols more readily advance into the peripheral lung. We performed in silico modeling to confirm the secondary pulmonary lobules as the primary site of disease initiation. By taking different anatomical aerosol origins into consideration and reflecting aerosols from exhalation maneuvers breathing and vocalization, the physicochemical properties of generated respiratory aerosol particles were defined upon conversion to droplet nuclei by evaporation at ambient air. To provide detailed, spatially-resolved information on particle deposition in the thoracic region of the lung, a top-down refinement approach was employed. Our study presents evidence for hot spots of aerosol deposition in lung generations beyond the terminal bronchiole, with a maximum in the secondary pulmonary lobules and a high preference to the lower lobes of both lungs. In vivo, initial chest CT anomalies, the ground glass opacities, resulting from partial alveolar filling and interstitial thickening in the secondary pulmonary lobules, are likewise localized in these lung generations, with the highest frequency in both lower lobes and in the early stage of disease. Hence, our results suggest a disease initiation right there upon inhalation of virion-laden respiratory aerosols, linking the aerosol transmission route to pathogenesis associated with higher disease burden and identifying aerosol transmission as a new independent risk factor for developing a pulmonary phase with a severe outcome.

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