Post-COVID-19 Patients Who Develop Lung Fibrotic-like Changes Have Lower Circulating Levels of IFN-β but Higher Levels of IL-1α and TGF-β

Purpose: SARS-CoV-2 infection induces in some patients a condition called long-COVID-19, herein post-COVID-19 (PC), which persists for longer than the negative oral-pharyngeal swab. One of the complications of PC is pulmonary fibrosis. The purpose of this study was to identify blood biomarkers to predict PC patients undergoing pulmonary fibrosis. Patients and Methods: We analyzed blood samples of healthy, anti-SARS-CoV-2 vaccinated (VAX) subjects and PC patients who were stratified according to the severity of the disease and chest computed tomography (CT) scan data. Results: The inflammatory C reactive protein (CRP), complement complex C5b-9, LDH, but not IL-6, were higher in PC patients, independent of the severity of the disease and lung fibrotic areas. Interestingly, PC patients with ground-glass opacities (as revealed by chest CT scan) were characterized by higher plasma levels of IL-1α, CXCL-10, TGF-β, but not of IFN-β, compared to healthy and VAX subjects. In particular, 19 out of 23 (82.6%) severe PC and 8 out of 29 (27.6%) moderate PC patients presented signs of lung fibrosis, associated to lower levels of IFN-β, but higher IL-1α and TGF-β. Conclusions: We found that higher IL-1α and TGF-β and lower plasma levels of IFN-β could predict an increased relative risk (RR = 2.8) of lung fibrosis-like changes in PC patients.

A Case of Rubella Caused by Rubella Vaccination

We present an extremely rare case of rubella that developed after rubella vaccine administration. A 54-year-old man complained of back and neck pain for some days. He presented with generalized rash and arthralgia that had persisted for two days before his visit. His vital signs were normal, and arthralgia had disappeared during an examination, but lymphadenopathy in the left posterior neck and pink papules were observed throughout the body. He had received his first Rubella vaccination 17 days before this visit and had attended a crowded festival. Owing to the rubella epidemic in that prefecture, we performed a rubella antibody test and polymerase chain reaction assay using blood, urine, and pharyngeal swab specimens. Rubella IgG and IgM antibody titers were 3 and 1.48, respectively. The pharyngeal swab yielded positive results for the 1a vaccine strain. Therefore, he was diagnosed with rubella due to rubella vaccination. His symptoms improved eventually. His clinical course was uncomplicated. Symptoms resolved within one week without specific treatment. The vaccine rubella strain is not as highly infectious as wild-type rubella strains. If rubella symptoms appear after vaccination, it must be investigated whether these are vaccine-specific adverse reactions, wild-strain rubella onset, or other eruptive viral infections.

Ocular manifestations and SARS-CoV-2 detection in tears and conjunctival scrape from non-severe COVID-19 patients

AIM: To explore the ocular features of corona virus disease (COVID)-19 and severe acute respiratory syndrome coronavirus (SARS-CoV)-2 detection in tears and conjunctival scrapes in non-severe COVID-19 patients. METHODS: This is a multicenter observational clinical study with no intervention conducted from Jan 25th to March 1st, 2020. Clinical data and samples of tears and conjunctival scraping were collected in consecutive laboratory-confirmed, non-severe COVID-19 patients from three hospitals. COVID-19 virus was analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) kits. RESULTS: Totally 255 laboratory-confirmed, non-severe COVID-19 patients were recruited for ocular manifestation investigation. Of them, 54.9% were females, with a mean age of 49.4y. None of the patients has evidence of uveitis; 11 patients (4.3%) complained of mild asthenopia; 2 (0.8%) had mild conjunctival congestion and serous secretion. Twenty-five of them had performed tears and conjunctival scrape for COVID-19 virus detection, with 4 yield possible positive results in the nucleoprotein gene. One of them were asymptomatic with normal chest CT and positive pharyngeal swab result. CONCLUSION: Ocular manifestations are neither common nor specific in non-severe COVID-19 patients. Meanwhile, COVID-19 virus nucleotides can be detected in the tears and conjunctival scrape samples, warranting further research on the transmissibility by the ocular route.

Clinical presentation and CT features in pediatric patients with COVID‐19 infection

Background The aim of this study includes to discuss the clinical, laboratory, and chest computed tomography (CT) in pediatric patients with 2019 novel coronavirus (COVID-19) infection. Material and Methods The clinical, laboratory, and chest CT features of 17 pediatric inpatients with COVID-19 infection confirmed by pharyngeal swab COVID‐19 polymerase chain reaction(PCR). All clinical and laboratory data have been recorded and analyzed during march-february 2021. Chest CT have been performed to all Covid 19 PCR confirmed patients and radiologicall view have been noted. Results Seventeen pediatric patients with a history of close contact with COVID-19 diagnosed family members included to the study. Fever (10/17, 58%) and cough (13/17, 76%) were the most common symptoms. For laboratory findings, c reactive protein elevation (15/17, 88%) seem to be the most finding. A total of 4 patients presented with unilateral pulmonary lesions (4/17, 23%), 9 with bilateral pulmonary lesions (9/17, 52%) and 13 cases showed bilateral diffuse covid pattern on chest CT (13/17, 76%). Non-spesific consolidation with was observed in 8 patients (8/17, 47%), ground‐glass opacities were observed in 11 patients (11/17, 64%), nodules were observed in 7 patients (7/17, 41%), and tiny nodules were observed in 2 patients (2/17, 11%). Conclusion In pediatric patients with positive COVID-19 nucleic acid test from pharyngeal swab samples; the early detection of lesions by CT can be efficient; in management and early treatment for pediatric patients. However; early chest CT screening and COVİD-19 PCR testing together can be more efficent in diagnose.

COVID-19 and beyond: development of a comprehensive telemedical diagnostic framework

Purpose During the COVID-19 pandemic, a threatening bottleneck of medical staff arose due to a shortage of trained caregivers, who became infected while working with infectious patients. While telemedicine is rapidly evolving in the fields of teleconsultation and telesurgery, proper telediagnostic systems are not yet available, although the demand for contactless patient–doctor interaction is increasing. Methods In this project, the current limitations were addressed by developing a comprehensive telediagnostic system. Therefore, medical examinations have been assessed in collaboration with medical experts. Subsequently, a framework was developed, satisfying the relevant constraints of medical-, technical-, and hygienic- aspects in order to transform in-person examinations into a contactless procedure. Diagnostic steps were classified into three groups: assisted procedures carried out by the patient, teleoperated examination methods, and adoptions of conventional methods. Results The Telemedical Diagnostic Framework was implemented, resulting in a functional proof of concept, where potentially infectious patients could undergo a full medical examination. The system comprises, e.g., a naso-pharyngeal swab, an inspection of the oral cavity, auscultation, percussion, and palpation, based on robotic end-effectors. The physician is thereby connected using a newly developed user-interface and a lead robot, with force feedback control, that enables precise movements with the follower robot on the patient’s side. Conclusion Our concept proves the feasibility of a fully telediagnostic system, that consolidates available technology and new developments to an efficient solution enabling safe patient-doctor interaction. Besides infectious situations, this solution can also be applied to remote areas.

Post-discharge telephonic follow-up of pediatric patients affected by SARS-CoV2 infection in a single Italianpediatric COVID center: a safe and feasible way to monitor children after hospitalization

Background SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. Materials and methods Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. Results During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. Conclusion Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

POS1201 Incidence and outcome of COVID-19 in ANCA-associated vasculitis: impact of COVID-19 in patients undergoing rituximab for maintenance

Background:COVID-19 is an emerging infectious disease caused by SARS-CoV-2. Risk factors for the worst outcome in COVID-19 are pre-existing pulmonary and cardiovascular disease, while the impact of chronic immunosuppression has not yet completely been clarified (1).Currently, there is no clinical evidence that chronically immunosuppressed rheumatic patients under biologic agent or a small molecule may have a higher risk of COVID-19 or a worse prognosis(2). However, the anti-CD20 antibody monoclonal rituximab may contribute to severe consequences, inhibiting the humoral response to SARS-CoV-2 and capacity to produce efficient antibodies against it (3,4). Rituximab is widely use in the treatment of ANCA-associated vasculitis (AAV). Nowadays, the incidence and impact of COVID-19 in AAV-patients are still unknown and, in particular, in AAV-patients who have been exposed to rituximab since the outbreak (5).Objectives:Herein we evaluate the incidence and outcome of SARS-CoV-2 infection in our cohort of AAV-patients who had at least one visit in the year 2020.Methods:We collected clinical data of 100 AAV-patients who had at least one visit in our Centre from February 2020 to December 2020, and we described cases of COVID-19 infection among them. The COVID-19 was proved by detection of SARS-CoV-2 RNA in nose-pharyngeal swabs. In case of infection, anti-SARS-CoV-2 IgM or IgG production was then investigated.Results:Among 100 patients (53 females; 47 males) regularly followed, the median age was 65, and the mean (SD) duration of disease was 8.8 (6.8) years. The most frequent diagnosis was granulomatosis with polyangiitis (GPA) (56%), followed by granulomatosis eosinophilic with polyangiitis (EGPA) (31%), and microscopic polyangiitis (MPA) (13%). The mean (SD) BVASv3 at the onset of disease was 12.6 (5.6). More than half of the patients (59%) have had lung and/or ENT involvement at the onset of disease. Overall, 84% of our patients received immunosuppressive agents and 45% also received glucocorticoids (GC). Rituximab was administered in 15% of patients during the pandemic. COVID-19 was diagnosed in 2 cases (2%). Both patients have received rituximab as maintenance: the last rituximab infusion was on November 9, 2020 for patient 1 (female, 73 years old, GPA ANCA-PR3+) and was on August 17, 2020 for patient 2 (female, 74 years old, MPA ANCA-MPO+). Both patients had a BVAS 0 and negative ANCA antibodies at the time of the first positive nose-pharyngeal swab RT-PCR test, on December 24 and on November 25, respectively. Both patients were B-cell depleted and IgG levels were 455 mg/dL and 866 mg/dL, respectively. While patient 1 died due to critically ill COVID-19 pneumonia 25 days after the COVID-19 disease onset, patient 2 remained asymptomatic with nose-pharyngeal swab still positive on day 56 after the first detection. Anti-SARS-CoV-2 IgM or IgG antibodies above the cut-off (cut-off value 10 AU/mL) were absent in patient 1, while in patient 2 a low level of anti-SARS-CoV-2 IgG (39 AU/mL, cut-off value 10 AU/mL) was documented.Conclusion:Prevalence of COVID-19 in AAV seems lower than in general population (prevalence of 29582/466700, 6.3%, in the same geographical area). Rituximab compromises the B-cells function and can lead to humoral immunodeficiency, causing the inability to produce anti-SARS-CoV-2 IgG antibodies. The timing of the last rituximab infusion and the levels of IgG can greatly affect the outcome. Patients who underwent anti-CD20 therapy are at higher risk of severe outcome in case of infection (3), and require prioritization for SARS-CoV-2 vaccination.References:[1]Guilpain P, et al. Ann Rheum Dis. 2021;80(1):e10.[2]Quartuccio L, et al. Joint Bone Spine. 2020;87(5):439–43.[3]Benucci M, et al. Ann Rheum Dis. 2020; Aug 4:annrheumdis-2020-218590.[4]Tepasse P-R, et al. Br J Haematol. 2020;190(2):185–8.[5]Kant S, et al. J Nephrol. 2020; J Nephrol. 2020 Oct 8:1-6.Disclosure of Interests:None declared.

Does COVID-19 transmitted transplacental?

We presented at 38+ pregnant patient with proven SARS-Cov-2 infection who presented in labor during the pandemic and delivered a baby with positive SARS-CoV-2. To study the risk of transplacental transmission of SARS-Cov-2 infection by obtaining nasal pharyngeal swab of mother and baby and urine & LP culture for baby as well as placental tissue. All specimens were negative except nasopharyngeal sample, so transplacental transmission couldn’t be proved.

Factors associated with SARS-CoV-2 infection and outcome in patients with solid tumors or hematological malignancies: a single-center study

Background Immunocompromised cancer patients are presumed to be at high risk of developing COVID-19 infection. Predisposing factors to contracting COVID-19 and to severe outcomes have been described in registries but were not compared between solid tumors and hematological malignancies. Method This retrospective single oncologic center study included adults with solid tumors or hematological malignancies referred to testing by naso-pharyngeal swab for a SARS-CoV-2 RT-PCR from March 10 to May 18, 2020. Results A total of 212 patients were included in the study. Forty-five (21%) were tested positive with SARS-CoV-2. The univariate analysis with positive SARS-CoV-2 PCR as a dependent variable reveals significant odds ratios (ORs) for age—with a mean of 62.5 years—(OR: 1.05, 95% CI: 1.02–1.08), performance status ≥2 (OR: 2.38, 95% CI: 1.22–4.70), inpatient status (OR: 2.36, 95%CI: 1.11–4.91), and hematological malignancies (OR: 2.48, 95% CI: 1.23–4.96). In contrast, OR for solid tumors reveals a negative association (OR: 0.40, 95% CI: 0.20–0.81). When integrating severe outcome (ICU admission or COVID-19-related death) as a dependent variable, the univariate logistic regression model shows significant ORs for pre-existing lymphopenia (OR: 4.0, 95% CI: 1.17–15.04), hematological malignancies (OR: 3.73, 95% CI: 1.09–13.80), and a negative association for solid tumors (OR: 0.27; 95% CI: 0.07–0.92). Conclusion In patients referred for SARS-CoV-2 testing, hematological malignancies were associated with a higher risk of COVID-19 infection and severe outcomes. Other factors were age and inpatient status.