Comparison of the AllplexTM Respiratory Panel Assays and the automated Fast Track Diagnostics Respiratory pathogens 21 assay for the diagnosis of pediatric respiratory viral infections.
Concato C1, Piccioni L2, Ranno S1, Antonelli F3, Buonomini A3, Coltella L1, Pizzichemi G1, Chiavelli S1, Riva E3.
Abstract
Acute respiratory tract infections frequently occur in children and represent one of the leading causes of morbidity and mortality worldwide. Quick and accurate pathogen detection can lead to a more appropriate use of antimicrobial treatment as well as timely implementation of isolation precautions. In the last decade, several commercial assays have been developed for the simultaneous diagnosis of respiratory pathogens, which substantially vary in formulation and performance characteristics. The aim of this study was to compare the performance of the "AllplexTM Respiratory Panel Assays" (Seegene) with that of the automated "Fast Track Diagnostics Respiratory pathogens 21" assay (Siemens) for the diagnosis of pediatric respiratory viral infections. One hundred forty-five nasopharyngeal wash samples, collected at the Bambino Gesù Pediatric Hospital in Rome during the fall-winter 2017-2018 season, were processed and analyzed with both workflows. Our results suggest a high concordance between the two methods for positive and negative samples. Sensitivity and specificity were calculated with both tests as a reference method. For the AllplexTM Respiratory Panel Assays, they were 98% and 100%, respectively, and for the Fast Track Diagnostics Respiratory pathogens 21 assay, they were both 100%. This comparative study allowed us to highlight the characteristics of the two assays to evaluate the best solution, on the basis of diagnostic routine and laboratory workflows, keeping in mind local epidemiology.
2.
JAMA Otolaryngol Head Neck Surg. 2020 Mar 31. doi: 10.1001/jamaoto.2020.0780. [Epub ahead of print]
Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic.
Givi B1, Schiff BA2, Chinn SB3, Clayburgh D4, Iyer NG5, Jalisi S6, Moore MG7, Nathan CA8, Orloff LA9, O'Neill JP10, Parker N7, Zender C11, Morris LGT12, Davies L13.
Abstract
IMPORTANCE:
The rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists-head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic.
OBSERVATIONS:
A high number of health care workers were infected during the first phase of the pandemic in the city of Wuhan, China. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for health care workers without jeopardizing the care of patients. The most common procedures related to the examination and treatment of upper aerodigestive tract diseases were reviewed. Each category was reviewed based on the potential risk imposed to health care workers. Specific recommendations were made based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in patients with COVID-19.
CONCLUSIONS AND RELEVANCE:
Preserving a highly skilled health care workforce is a top priority for any community and health care system. Based on the experience of health care systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of health care workers could be greatly reduced while providing high levels of care. The provided recommendations, which may evolve over time, could be used as broad guidance for all health care workers who are involved in the care of patients with COVID-19.
3.
J Clin Med Res. 2020 Mar;12(3):142-149. doi: 10.14740/jocmr4058. Epub 2020 Mar 2.
MAC Attack: Clinical Correlates of Mycobacterium avium Complex Infection Among Patients With and Without Cancer.
Abstract
BACKGROUND:
In 2007 the American Thoracic Society (ATS) released guidelines on management of Mycobacterium avium complex (MAC), an increasingly common respiratory organism worldwide. Determining when this represents a true respiratory pathogen remains controversial and becomes increasingly challenging in patients with cancer. This study aims to 1) describe the phenotype that exists among cancer patients with MAC colonization and MAC pulmonary infection when compared to non-cancer patients; 2) assess whether cancer, symptoms, and radiographs, were associated with the decision to treat MAC pulmonary infection with antibiotics.
METHODS:
We retrospectively analyzed 550 adult, non-human immunodeficiency virus (HIV) patients, among whom MAC was identified in respiratory cultures or tissue. Radiographs, clinical symptoms and cancer status were studied. Patients were categorized as having MAC pulmonary infection based on 2007 ATS guidelines, and antibiotic treatment was thereafter reviewed. Fisher's exact test and Wilcoxon Rank sum assessed differences.
RESULTS:
Median age of the 550 patients was 68 years; most were female (56%) and white (83%). Symptoms and radiographic abnormalities accompanying MAC isolation were common, occurring among 83% and 99.6% respectively of all patients. There were 444 patients with MAC who had current or inactive cancers, most commonly hematologic (30%) and lung (25%) malignancies, while 106 patients never had cancer. Cancer patients were younger (P = 0.028), less often female (P < 0.001), and had less-frequent pre-existing lung disease (P = 0.017) than those without cancer. There were 196 (35%) patients determined to have MAC pulmonary infection, among whom 49 (9%) received directed antibiotics. Those receiving antibiotics had lower body mass index (BMI) (P < 0.0001), more frequent pre-existing lung disease (P = 0.003) and lower cancer rates (P = 0.008) than those not receiving antibiotics. Patients receiving antibiotics were more likely to have cavitary disease (P = 0.001), cough/dyspnea (P = 0.012), hemoptysis (P < 0.001), and constitutional symptoms (P = 0.001).
CONCLUSIONS:
In concordance with ATS guidelines, hemoptysis, constitutional symptoms, cough/dyspnea and cavitary disease were associated with highest likelihood to treat with antibiotics. The phenotype in cancer patients was quite different than the classic Lady Windermere syndrome. MAC pulmonary infection was treated less often in cancer patients. This study extends beyond the ATS guidelines to examine the potential import of malignancy on the colonization and potential treatment of MAC.
Copyright 2020, Gupta et al.
KEYWORDS:
Anti-bacterial agents; Lung diseases; Mycobacterium avium; Neoplasms; Nontuberculous mycobacteria; Respiratory tract infections; Tomography; Treatment outcome
4.
Case Rep Neurol. 2020 Feb 28;12(1):92-96. doi: 10.1159/000506191. eCollection 2020 Jan-Apr.
Anti-Ganglioside Antibody-Negative Miller Fisher and AMSAN Variant Guillain-Barré Overlap Syndrome.
Abstract
A case of Miller Fisher and acute motor sensory axonal neuropathy (AMSAN) variant Guillain-Barré (MFS/AMSAN-GBS) overlap syndrome is presented. The neurological presentation of the overlap syndrome was preceded by an upper respiratory tract infection. Eventually, severe weakness of bulbar and limb muscles, areflexia, ophthalmoplegia, ataxia, and respiratory insufficiency developed. The electroneuromyography revealed symmetrical axonal polyneuropathy which was dominant in both upper limbs. Although a panel of anti-ganglioside antibodies including anti-GQ1b was negative, immediate treatment with intravenous immunoglobulin resulted in dramatic response.
Copyright © 2020 by S. Karger AG, Basel.
KEYWORDS:
Demyelinating disease; Guillain-Barré syndrome
5.
PLoS Med. 2020 Mar 31;17(3):e1003058. doi: 10.1371/journal.pmed.1003058. eCollection 2020 Mar.
Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study.
Abstract
BACKGROUND:
Evidence and guidelines do not support use of systemic steroids for acute respiratory tract infections (ARTIs), but such practice appears common. We aim to quantify such use and determine its predictors.
METHODS AND FINDINGS:
We conducted a cohort study based on a large United States national commercial claims database, the IBM MarketScan, to identify patients aged 18-64 years with an ARTI diagnosis (acute bronchitis, sinusitis, pharyngitis, otitis media, allergic rhinitis, influenza, pneumonia, and unspecified upper respiratory infections) recorded in ambulatory visits from 2007 to 2016. We excluded those with systemic steroid use in the prior year and an extensive list of steroid-indicated conditions, including asthma, chronic obstructive pulmonary disease, and various autoimmune diseases. We calculated the proportion receiving systemic steroids within 7 days of the ARTI diagnosis and determined its significant predictors. We identified 9,763,710 patients with an eligible ARTI encounter (mean age 39.6, female 56.0%) and found 11.8% were prescribed systemic steroids (46.1% parenteral, 47.3% oral, 6.6% both). All ARTI diagnoses but influenza predicted receiving systemic steroids. There was high geographical variability: the adjusted odds ratio (aOR) of receiving parenteral steroids was 14.48 (95% confidence interval [CI] 14.23-14.72, p < 0.001) comparing southern versus northeastern US. The corresponding aOR was 1.68 (95% CI 1.66-1.69, p < 0.001) for oral steroids. Other positive predictors for prescribing included emergency department (ED) or urgent care settings (versus regular office), otolaryngologist/ED doctors (versus primary care), fewer comorbidities, and older patient age. There was an increasing trend from 2007 to 2016 (aOR 1.93 [95% CI 1.91-1.95] comparing 2016 to 2007, p < 0.001). Our findings are based on patients between 18 and 64 years old with commercial medical insurance and may not be generalizable to older or uninsured populations.
CONCLUSIONS:
In this study, we found that systemic steroid use in ARTI is common with a great geographical variability. These findings call for an effective education program about this practice, which does not have a clear clinical net benefit.
6.
Pediatr Emerg Care. 2020 Mar 30. doi: 10.1097/PEC.0000000000002091. [Epub ahead of print]
Evaluation of the Pattern of Use of a Pediatric Emergency Department in Italy.
Abstract
OBJECTIVES:
The aim of this study was to evaluate access to a pediatric emergency department (PED) in a large hospital, in particular to estimate the prevalence of potentially avoidable accesses and the characteristics of return visits.
METHODS:
Clinical health records from the PED of San Gerardo Hospital, Monza, Italy, were retrospectively reviewed. The study population was composed of subjects younger than 18 years who attended the PED during the period from October 1, 2017, to November 30, 2017.Accesses were defined nonurgent if characterized by white or green triage codes and patient's discharge as the outcome and were defined potentially avoidable if nonurgent and with no diagnostic/therapeutic procedures performed except a visit by the ED pediatrician.Return visits were defined as accesses that occurred within 72 hours of the first index visit.
RESULTS:
A total of 2064 children and adolescents younger than 18 years had at least 1 ED attendance between October and November 2017, for a total of 2364 accesses.The most frequent diagnoses were upper respiratory tract infections (29.5% of accesses), followed by gastroenteritis (7.0%) and abdominal pain (7.0%). In all, 1810 accesses (88%) were classified as "nonurgent," and 1228 (60%) potentially avoidable, 373 of which were probably avoidable because they occurred when the primary care physician was available.The number of return visits was 98 (5% of the accesses): 74 were nonurgent, 31 of which potentially avoidable. On 17 occasions, both index and return visits were potentially avoidable.
CONCLUSIONS:
We confirm that most of the accesses to a PED are nonurgent and potentially avoidable. Interventions are needed to improve the appropriateness of use of emergency services.
7.
R I Med J (2013). 2020 Mar 26;103(3):50-51.
COVID-19 in a Patient Presenting with Syncope and a Normal Chest X-ray.
Abstract
SARS-CoV-2 is a novel virus that has now affected hundreds of thousands of individuals across the world. Amidst this global pandemic, maintaining a high index of suspicion, rapid testing capacity, and infection control measures are required to curtail the virus' rapid spread. While fever and respiratory symptoms have been commonly used to identify COVID-19 suspects, we present an elderly female who arrived to the hospital after a syncopal episode. She was afebrile with a normal chest X-ray and there was no suspicion of COVID-19. She then developed a fever and tested positive for COVID-19. Our unique case underscores the increasing diversity of COVID-19 presentations and potential for initial mis- diagnosis and delay in implementing proper precautions.
KEYWORDS:
COVID-19; SARS-CoV-2; chest radiograph; imaging; isolation precautions; syncope
8.
Medwave. 2020 Mar 27;20(2):e7861. doi: 10.5867/medwave.2020.02.7861.
Number of COVID-19 cases in Chile at 120 days with data at 21/03/2020 and threshold of daily effort to flatten the epi-curve.
[Article in English, Spanish; Abstract available in Spanish from the publisher]
Abstract
We present a straightforward projection with data up to 21/03/2020 of the evolution of the number of COVID-19 cases per day in Chile using data from the Ministry of Health. Assuming an arithmetical growth in the second variation of the data, we present a cubic adjustment model in which we estimate over 100 000 cases at 120 days consistent with the data recorded to date. Furthermore, we use an exponential total case model to represent (using a parameter) the daily effort to reduce a high initial daily growth rate. We simulate this model with different numerical scenarios of feasibility and desired future prevalence.
KEYWORDS:
epidemiology; mathematical models; coronavirus
9.
West J Emerg Med. 2020 Mar 27;21(3). doi: 10.5811/westjem.2020.3.47348.
Preliminary Results of Initial Testing for Coronavirus (COVID-19) in the Emergency Department.
Abstract
INTRODUCTION:
On March 10, 2020, the World Health Organization declared a global pandemic due to widespread infection of the novel coronavirus 2019 (COVID-19). We report the preliminary results of a targeted program of COVID-19 infection testing in the ED in the first 10 days of its initiation at our institution.
METHODS:
We conducted a review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs during the initial 10 days of testing (March 10-19, 2020). During this initial period with limited resources, testing was targeted toward high-risk patients per Centers for Disease Control and Prevention guidelines. Data collected from patients who were tested included demographics, clinical characteristics, and test qualifying criteria. We present the data overall and by test results with descriptive statistics.
RESULTS:
During the 10-day study period, the combined census of the study EDs was 2157 patient encounters. A total of 283 tests were ordered in the ED. The majority of patients were 18-64 years of age, male, non-Hispanic white, had an Emergency Severity Index score of three, did not have a fever, and were discharged from the ED. A total of 29 (10.2%) tested positive. Symptoms-based criteria most associated with COVID-19 were the most common criteria identified for testing (90.6%). All other criteria were reported in 5.51-43.0% of persons being tested. Having contact with a person under investigation was significantly more common in those who tested positive compared to those who tested negative (63% vs 24.5%, respectively). The majority of patients in both results groups had at least two qualifying criteria for testing (75.2%).
CONCLUSION:
In this review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs in the first 10 days of testing, we found that 10.2% of those tested were identified as positive. The continued monitoring of testing and results will help providers understand how COVID-19 is progressing in the community.
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 May 25;49(1):0.
[Follow-up testing of viral nucleic acid in discharged patients with moderate type of 2019 coronavirus disease (COVID-19)].
[Article in Chinese]
Abstract
OBJECTIVE:
To investigate the clinical outcome of patients with moderate type of corona virus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.
METHODS:
Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantine in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the three weeks of quarantined period, the symptoms and signs were documented; and sputum or nasal swab and feces samples were collected to test SARS-COV-2 nucleic acid by RT-PCR method.
RESULTS:
There were no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-COV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.
CONCLUSIONS:
The study indicates that there is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.
11.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 May 25;49(1):0.
[Management of a colon cancer patient infected with corona virus disease 2019].
[Article in Chinese]
Abstract
OBJECTIVE:
To explore the feasibility of surgical treatment for cancer patients complicated with corona virus disease 2019 (COVID-19).
METHODS:
The management and clinical outcome of a sigmoid cancer patient with COVID-19 were analyzed.
RESULTS:
The inflammation indicators and fever of this patient were effectively controlled and the lung lesions remained stable after active anti-viral treatment, then the radical colorectomy was performed after the viral negative conversion for twice.
CONCLUSIONS:
The case indicates that it may feasible to undergo radical tumor surgery for cancer patients with COVID-19 after the virus nucleic acid testing turns negative and more studies are needed to confirm this conclusion.
12.
Science. 2020 Mar 27;367(6485):1436. doi: 10.1126/science.abb6950.
Travel restrictions violate international law.
13.
Science. 2020 Mar 27;367(6485):1436. doi: 10.1126/science.abb3088.
COVID-19 drives new threat to bats in China.
Zhao H1.
14.
Science. 2020 Mar 27;367(6485):1414-1415. doi: 10.1126/science.367.6485.1414-b.
With COVID-19, modeling takes on life and death importance.
15.
Science. 2020 Mar 27;367(6485):1414. doi: 10.1126/science.367.6485.1414-a.
Fauci's straight talk.
16.
Science. 2020 Mar 27;367(6485):1412-1413. doi: 10.1126/science.367.6485.1412.
Race to find COVID-19 treatments accelerates.
17.
Respir Res. 2020 Mar 26;21(1):74. doi: 10.1186/s12931-020-01338-8.
Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis.
Abstract
BACKGROUND:
Since December 2019, 2019 novel coronavirus pneumonia emerged in Wuhan city and rapidly spread throughout China and even the world. We sought to analyse the clinical characteristics and laboratory findings of some cases with 2019 novel coronavirus pneumonia .
METHODS:
In this retrospective study, we extracted the data on 95 patients with laboratory-confirmed 2019 novel coronavirus pneumonia in Wuhan Xinzhou District People's Hospital from January 16th to February 25th, 2020. Cases were confirmed by real-time RT-PCR and abnormal radiologic findings. Outcomes were followed up until March 2th, 2020.
RESULTS:
Higher temperature, blood leukocyte count, neutrophil count, neutrophil percentage, C-reactive protein level, D-dimer level, alanine aminotransferase activity, aspartate aminotransferase activity, α - hydroxybutyrate dehydrogenase activity, lactate dehydrogenase activity and creatine kinase activity were related to severe 2019 novel coronavirus pneumonia and composite endpoint, and so were lower lymphocyte count, lymphocyte percentage and total protein level. Age below 40 or above 60 years old, male, higher Creatinine level, and lower platelet count also seemed related to severe 2019 novel coronavirus pneumonia and composite endpoint, however the P values were greater than 0.05, which mean under the same condition studies of larger samples are needed in the future.
CONCLUSION:
Multiple factors were related to severe 2019 novel coronavirus pneumonia and composite endpoint, and more related studies are needed in the future.
KEYWORDS:
2019 novel coronavirus; Clinical characteristics; Laboratory findings; Pneumonia
- PMID:
- 32216803
- PMCID:
- PMC7099829
- DOI:
- 10.1186/s12931-020-01338-8
- [Indexed for MEDLINE]
18.
Pharm Res. 2020 Mar 25;37(4):71. doi: 10.1007/s11095-020-02799-8.
Tilorone: a Broad-Spectrum Antiviral Invented in the USA and Commercialized in Russia and beyond.
Abstract
For the last 50 years we have known of a broad-spectrum agent tilorone dihydrochloride (Tilorone). This is a small-molecule orally bioavailable drug that was originally discovered in the USA and is currently used clinically as an antiviral in Russia and the Ukraine. Over the years there have been numerous clinical and non-clinical reports of its broad spectrum of antiviral activity. More recently we have identified additional promising antiviral activities against Middle East Respiratory Syndrome, Chikungunya, Ebola and Marburg which highlights that this old drug may have other uses against new viruses. This may in turn inform the types of drugs that we need for virus outbreaks such as for the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tilorone has been long neglected by the west in many respects but it deserves further reassessment in light of current and future needs for broad-spectrum antivirals.
KEYWORDS:
Antiviral; broad spectrum; interferon inducers; respiratory virus infections
- PMID:
- 32215760
- PMCID:
- PMC7100484
- DOI:
- 10.1007/s11095-020-02799-8
- [Indexed for MEDLINE]
19.
Epidemiol Serv Saude. 2020 Mar 23;29(1):e2020002. doi: 10.5123/S1679-49742020000100021.
Immediate Health Surveillance Response to COVID-19 Epidemic.
[Article in English, Portuguese]
20.
Pain Physician. 2020 Mar;23(2):E71-E83.
Expanded Umbilical Cord Mesenchymal Stem Cells (UC-MSCs) as a Therapeutic Strategy in Managing Critically Ill COVID-19 Patients: The Case for Compassionate Use.
Abstract
COVID-19 has affected the United States leading to a national emergency with health care and economic impact, propelling the country into a recession with disrupted lifestyles not seen in recent history. COVID-19 is a serious illness leading to multiple deaths in various countries including the United States. Several million Americans satisfy the Center for Disease Control and Prevention (CDC) criteria for being high risk. Unfortunately, the available supply of medical beds and equipment for mechanical ventilation are much less than is projected to be needed. The World Health Organization (WHO) and multiple agencies led by the CDC in the United States have attempted to organize intensive outbreak investigation programs utilizing appropriate preventive measures, evaluation, and treatment. The clinical spectrum of COVID-19 varies from asymptomatic forms to conditions encompassing multiorgan and systemic manifestations in terms of septic shock, and multiple organ dysfunction (MOD) syndromes. The presently approved treatments are supportive but not curative for the disease. There are multiple treatments being studied. These include vaccines, medications Remdesivir and hydroxychloroquine and potentially combination therapy. Finally, expanded umbilical cord mesenchymal stem cells or (UC-MSCs) may have a role and are being studied. The cure of COVID-19 is essentially dependent on the patients' own immune system. When the immune system is over activated in an attempt to kill the virus, this can lead to the production of a large number of inflammatory factors, resulting in severe cytokine storm. The cytokine storm may induce organ damage followed by the edema, dysfunction of air exchange, acute respiratory distress syndrome (ARDS), acute cardiac injury, and secondary infection, which may lead to death. Thus, at this point, the avoidance of the cytokine storm may be the key for the treatment of HCOV-19 infected patients.In China, where there was limited availability of effective modalities to manage COVID-19 several patients were treated with expanded UC-MSCs. Additionally, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care have reported guidelines to treat coronavirus patients with stem cells in the hope of decreasing the number of patients going to the ICU, and, also relatively quickly getting them out of ICU. In this manuscript, we describe the urgent need for various solutions, pathogenesis of coronavirus and the clinical evidence for treatment of COVID-19 with stem cells. The limited but emerging evidence regarding UC MSC in managing COVID-19 suggests that it might be considered for compassionate use in critically ill patients to reduce morbidity and mortality in the United States. The administration and Coronavirus Task Force might wish to approach the potential of expanded UC-MSCs as an evolutionary therapeutic strategy in managing COVID-19 illness with a 3-pronged approach: If proven safe and effective on a specific and limited basis…1. Minimize regulatory burden by all agencies so that critically ill COVID-19 patients will have access regardless of their financial circumstance.2. Institute appropriate safeguards to avoid negative consequences from unscrupulous actors.3. With proper informed consent from patients or proxy when necessary, and subject to accumulation of data in that cohort, allow the procedure to be initiated in critically ill patients who are not responding to conventional therapies.KEY WORDS: Coronavirus, COVID-19, cytokine storm, multiorgan failure, expanded umbilical cord mesenchymal stem cells.
21.
BMJ. 2020 Mar 25;368:m1182. doi: 10.1136/bmj.m1182.
Covid-19: a remote assessment in primary care.
23.
N Engl J Med. 2020 Mar 26;382(13):e32. doi: 10.1056/NEJMe2006742.
Audio Interview: Practical Measures to Help Prevent Covid-19.
24.
N Engl J Med. 2020 Mar 26;382(13):1280-1281. doi: 10.1056/NEJMc1913327.
Telacebec (Q203), a New Antituberculosis Agent.
de Jager VR1, Dawson R2, van Niekerk C3, Hutchings J3, Kim J3, Vanker N4, van der Merwe L5, Choi J3, Nam K3, Diacon AH6.
25.
Monaldi Arch Chest Dis. 2020 Mar 25;90(1). doi: 10.4081/monaldi.2020.1284.
COVID-19 in intensive care. Some necessary steps for health care workers.
Abstract
Due to the nature of their profession, health care personnel (HCP) have always been easy targets for transmission of communicable diseases like COVID-19. Shielding HCPs is of consequential significance in ensuring continued health care for the whole population in addition to reducing further spread. Close contact, repeated contact and prolonged contact are unavoidable in the intensive care (IC) environment. It is not uncommon for IC-HCPs to get carried away during an emergent situation, such as that posed by a suddenly deteriorating patient, and forgo the protective barriers that protect them from contracting a communicable infection. Some notable precautionary measures are mentioned below. This is by no means an exhaustive list.
26.
Sci Data. 2020 Mar 24;7(1):106. doi: 10.1038/s41597-020-0448-0.
Epidemiological data from the COVID-19 outbreak, real-time case information.
Xu B1,2, Gutierrez B2,3, Mekaru S4,5, Sewalk K4, Goodwin L4, Loskill A4,6, Cohn EL4, Hswen Y4, Hill SC2, Cobo MM3,7, Zarebski AE8, Li S2,9, Wu CH10, Hulland E11,12, Morgan JD11,12, Wang L13,14, O'Brien K4, Scarpino SV15, Brownstein JS4,16, Pybus OG2, Pigott DM17,18, Kraemer MUG19,20,21.
Abstract
Cases of a novel coronavirus were first reported in Wuhan, Hubei province, China, in December 2019 and have since spread across the world. Epidemiological studies have indicated human-to-human transmission in China and elsewhere. To aid the analysis and tracking of the COVID-19 epidemic we collected and curated individual-level data from national, provincial, and municipal health reports, as well as additional information from online reports. All data are geo-coded and, where available, include symptoms, key dates (date of onset, admission, and confirmation), and travel history. The generation of detailed, real-time, and robust data for emerging disease outbreaks is important and can help to generate robust evidence that will support and inform public health decision making.
- PMID:
- 32210236
- PMCID:
- PMC7093412
- DOI:
- 10.1038/s41597-020-0448-0
- [Indexed for MEDLINE]
27.
Elife. 2020 Mar 25;9. pii: e57162. doi: 10.7554/eLife.57162.
Publishing in the time of COVID-19.
Abstract
eLife is making changes to its policies on peer review in response to the impact of COVID-19 on the scientific community.
© 2020, Eisen et al.
KEYWORDS:
COVID-19; early-career researchers; peer review; preprints; scientific publishing
28.
Science. 2020 Mar 27;367(6485):1405. doi: 10.1126/science.abb8492. Epub 2020 Mar 23.
Underpromise, overdeliver.
Thorp HH1.
29.
Int J Environ Res Public Health. 2020 Mar 19;17(6). pii: E2032. doi: 10.3390/ijerph17062032.
The Impact of COVID-19 Epidemic Declaration on Psychological Consequences: A Study on Active Weibo Users.
Abstract
COVID-19 (Corona Virus Disease 2019) has significantly resulted in a large number of psychological consequences. The aim of this study is to explore the impacts of COVID-19 on people's mental health, to assist policy makers to develop actionable policies, and help clinical practitioners (e.g., social workers, psychiatrists, and psychologists) provide timely services to affected populations. We sample and analyze the Weibo posts from 17,865 active Weibo users using the approach of Online Ecological Recognition (OER) based on several machine-learning predictive models. We calculated word frequency, scores of emotional indicators (e.g., anxiety, depression, indignation, and Oxford happiness) and cognitive indicators (e.g., social risk judgment and life satisfaction) from the collected data. The sentiment analysis and the paired sample t-test were performed to examine the differences in the same group before and after the declaration of COVID-19 on 20 January, 2020. The results showed that negative emotions (e.g., anxiety, depression and indignation) and sensitivity to social risks increased, while the scores of positive emotions (e.g., Oxford happiness) and life satisfaction decreased. People were concerned more about their health and family, while less about leisure and friends. The results contribute to the knowledge gaps of short-term individual changes in psychological conditions after the outbreak. It may provide references for policy makers to plan and fight against COVID-19 effectively by improving stability of popular feelings and urgently prepare clinical practitioners to deliver corresponding therapy foundations for the risk groups and affected people.
KEYWORDS:
cognition; emotion; mental health; public health emergencies; word frequency analysis
30.
JAMA Netw Open. 2020 Mar 2;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976.
Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019.
Lai J1, Ma S2, Wang Y2, Cai Z2, Hu J1, Wei N1, Wu J3, Du H4, Chen T5, Li R2, Tan H2, Kang L2, Yao L2, Huang M1, Wang H6, Wang G2, Liu Z2, Hu S1.
Abstract
IMPORTANCE:
Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed.
OBJECTIVE:
To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.
DESIGN, SETTINGS, AND PARTICIPANTS:
This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible.
MAIN OUTCOMES AND MEASURES:
The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes.
RESULTS:
A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale-Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001).
CONCLUSIONS AND RELEVANCE:
In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.
Comment in
- Exercising Heart and Head in Managing Coronavirus Disease 2019 in Wuhan. [JAMA Netw Open. 2020]
- PMID:
- 32202646
- PMCID:
- PMC7090843
- DOI:
- 10.1001/jamanetworkopen.2020.3976
- [Indexed for MEDLINE]
31.
G Ital Cardiol (Rome). 2020 Apr;21(4):243-245. doi: 10.1714/3328.32981.
[COVID-19 coronavirus: what implications for Cardiology?]
[Article in Italian]
32.
Science. 2020 Mar 27;367(6485):1434. doi: 10.1126/science.abb8034. Epub 2020 Mar 20.
Misguided drug advice for COVID-19.
33.
Respir Res. 2020 Mar 20;21(1):72. doi: 10.1186/s12931-020-1329-y.
Sputum and blood transcriptomics characterisation of the inhaled PDE4 inhibitor CHF6001 on top of triple therapy in patients with chronic bronchitis.
Govoni M1, Bassi M2, Vezzoli S2, Lucci G2, Emirova A2, Nandeuil MA2, Petruzzelli S2, Jellema GL3, Afolabi EK3, Colgan B4, Leaker B5, Kornmann O6, Beeh KM7, Watz H8, Singh D9.
Abstract
BACKGROUND:
Although phosphodiesterase-4 (PDE4) inhibitors have been shown to reduce COPD exacerbation rate, their biological mechanism of action is not completely elucidated at the molecular level. We aimed to characterise the whole genome gene expression profile of the inhaled PDE4-inhibitor CHF6001 on top of triple therapy in sputum cells and whole blood of patients with COPD and chronic bronchitis.
METHODS:
Whole genome gene expression analysis was carried out by microarray in 54 patients before and after 32 days treatment with CHF6001 800 and 1600 μg and placebo twice daily (BID) in a randomised crossover study.
RESULTS:
CHF6001 had a strong effect in sputum, with 1471 and 2598 significantly differentially-expressed probe-sets relative to placebo (p-adjusted for False Discovery Rate < 0.05) with 800 and 1600 μg BID, respectively. Functional enrichment analysis showed significant modulation of key inflammatory pathways involved in cytokine activity, pathogen-associated-pattern-recognition activity, oxidative stress and vitamin D with associated inhibition of downstream inflammatory effectors. A large number of pro-inflammatory genes coding for cytokines and matrix-metalloproteinases were significantly differentially expressed for both doses; the majority (> 87%) were downregulated, including macrophage inflammatory protein-1-alpha and 1-beta, interleukin-27-beta, interleukin-12-beta, interleukin-32, tumour necrosis factor-alpha-induced-protein-8, ligand-superfamily-member-15, and matrix-metalloproteinases-7,12 and 14. The effect in blood was not significant.
CONCLUSIONS:
Inhaled PDE4 inhibition by CHF6001 on top of triple therapy in patients with COPD and chronic bronchitis significantly modulated key inflammatory targets and pathways in the lung but not in blood. Mechanistically these findings support a targeted effect in the lung while minimising unwanted systemic class-effects.
TRIAL REGISTRATION:
ClinicalTrial.gov, EudraCT, 2015-005550-35. Registered 15 July 2016.
KEYWORDS:
Biomarkers; Chronic obstructive pulmonary disease; Gene expression; Inflammation; Phosphodiesterase 4 inhibitors
- PMID:
- 32197620
- PMCID:
- PMC7085203
- DOI:
- 10.1186/s12931-020-1329-y
- [Indexed for MEDLINE]
34.
Infection. 2020 Apr;48(2):151-153. doi: 10.1007/s15010-020-01409-4.
Successful containment of COVID-19: the WHO-Report on the COVID-19 outbreak in China.
35.
Monaldi Arch Chest Dis. 2020 Mar 6;90(1). doi: 10.4081/monaldi.2020.1214.
Percutaneous lung abscess drainage: revisiting the old gold standard.
Abstract
Lung abscess is defined as the necrosis of lung tissue with cavity formation due to varied etiology. The treatment of lung abscesses is medical involving antibiotics and chest physiotherapy. The failure of medical line of management requires an invasive surgical or percutaneous approach for drainage and control of infection. While the literature is ample regarding the surgical approach, it is rather scarce on the percutaneous approach. The percutaneous drainage has been most studied with computed tomography guidance. With our case series we describe to the treatment of lung abscesses non-responsive to medical management, by a bedside minimally invasive ultrasound or fluoroscopy guided percutaneous drainage approach.
36.
Science. 2020 Mar 27;367(6485):1444-1448. doi: 10.1126/science.abb2762. Epub 2020 Mar 4.
Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2.
Abstract
Angiotensin-converting enzyme 2 (ACE2) is the cellular receptor for severe acute respiratory syndrome-coronavirus (SARS-CoV) and the new coronavirus (SARS-CoV-2) that is causing the serious coronavirus disease 2019 (COVID-19) epidemic. Here, we present cryo-electron microscopy structures of full-length human ACE2 in the presence of the neutral amino acid transporter B0AT1 with or without the receptor binding domain (RBD) of the surface spike glycoprotein (S protein) of SARS-CoV-2, both at an overall resolution of 2.9 angstroms, with a local resolution of 3.5 angstroms at the ACE2-RBD interface. The ACE2-B0AT1 complex is assembled as a dimer of heterodimers, with the collectrin-like domain of ACE2 mediating homodimerization. The RBD is recognized by the extracellular peptidase domain of ACE2 mainly through polar residues. These findings provide important insights into the molecular basis for coronavirus recognition and infection.
Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
37.
Monaldi Arch Chest Dis. 2020 Feb 27;90(1). doi: 10.4081/monaldi.2020.1146.
Application of CBNAAT (Xpert MTB/RIF assay) in new smear negative pulmonary tuberculosis patients.
Abstract
Presumptive pulmonary tuberculosis (PTB) patients whose sputum are detected to be smear negative for acid fast bacilli (AFB) present a significant challenge for a treating physician. Initiating these patients on anti tuberculous treatment (ATT) on empirical basis is not a good strategy as many were found to be sputum culture for tuberculosis negative on further evaluation according to many previous studies. In India due to resource limited settings and lack of knowledge about newest diagnostic modalities patients are often initiated only on the basis of characteristic clinical symptoms and chest radiographic abnormalities. This study was conducted to identify the advantage of application of sputum cartridge based nucleic acid amplification test (CBNAAT) in sputum AFB smear negative presumptive pulmonary TB patients. Our study concluded that clinical symptoms and radiological characteristics cannot differentiate TB patients from non-TB patients. Treating patients only on empirical basis would have resulted in unnecessary treatment of 41 patients.
38.
Surg Infect (Larchmt). 2020 Apr;21(3):299. doi: 10.1089/sur.2020.040. Epub 2020 Feb 25.
Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19.
39.
Biochemistry (Mosc). 2020 Feb;85(2):224-233. doi: 10.1134/S0006297920020091.
Complexes Formed via Bioconjugation of Genetically Modified TMV Particles with Conserved Influenza Antigen: Synthesis and Characterization.
Abstract
Recently we obtained complexes between genetically modified Tobacco Mosaic Virus (TMV) particles and proteins carrying conserved influenza antigen such as M2e epitope. Viral vector TMV-N-lys based on TMV-U1 genome was constructed by insertion of chemically active lysine into the exposed N-terminal part of the coat protein. Nicotiana benthamiana plants were agroinjected and TMV-N-lys virions were purified from non-inoculated leaves. Preparation was analyzed by SDS-PAGE/Coomassie staining; main protein with electrophoretic mobility of 21 kDa was detected. Electron microscopy confirmed the stability of modified particles. Chemical conjugation of TMV-N-lys virions and target influenza antigen M2e expressed in E. coli was performed using 5 mM 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide and 1 mM N-hydroxysuccinimide. The efficiency of chemical conjugation was confirmed by Western blotting. For additional characterization we used conventional electron microscopy. The diameter of the complexes did not differ significantly from the initial TMV-N-lys virions, but complexes formed highly organized and extensive network with dense "grains" on the surface. Dynamic light scattering demonstrated that the single peaks, reflecting the complexes TMV-N-lys/DHFR-M2e were significantly shifted relative to the control TMV-N-lys virions. The indirect enzyme-linked immunosorbent assay with TMV- and DHFR-M2e-specific antibodies showed that the complexes retain stability during overnight adsorption. Thus, the results allow using these complexes for immunization of animals with the subsequent preparation of a candidate universal vaccine against the influenza virus.
40.
Protein Cell. 2020 Apr;11(4):235-238. doi: 10.1007/s13238-020-00693-y.
Puzzle of highly pathogenic human coronaviruses (2019-nCoV).
41.
N Engl J Med. 2020 Mar 26;382(13):1194-1196. doi: 10.1056/NEJMp2002125. Epub 2020 Feb 19.
Defining the Epidemiology of Covid-19 - Studies Needed.
42.
N Engl J Med. 2020 Mar 26;382(13):1278-1280. doi: 10.1056/NEJMc2001899. Epub 2020 Feb 18.
Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China.
Hoehl S1, Rabenau H1, Berger A1, Kortenbusch M1, Cinatl J1, Bojkova D1, Behrens P2, Böddinghaus B2, Götsch U2, Naujoks F2, Neumann P2, Schork J2, Tiarks-Jungk P2, Walczok A2, Eickmann M3, Vehreschild MJGT1, Kann G1, Wolf T1, Gottschalk R2, Ciesek S4.
43.
Proc Natl Acad Sci U S A. 2020 Mar 24;117(12):6771-6776. doi: 10.1073/pnas.1922083117. Epub 2020 Feb 13.
Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection.
de Wit E1, Feldmann F2, Cronin J3, Jordan R4, Okumura A5, Thomas T3, Scott D2, Cihlar T4, Feldmann H3.
Abstract
The continued emergence of Middle East Respiratory Syndrome (MERS) cases with a high case fatality rate stresses the need for the availability of effective antiviral treatments. Remdesivir (GS-5734) effectively inhibited MERS coronavirus (MERS-CoV) replication in vitro, and showed efficacy against Severe Acute Respiratory Syndrome (SARS)-CoV in a mouse model. Here, we tested the efficacy of prophylactic and therapeutic remdesivir treatment in a nonhuman primate model of MERS-CoV infection, the rhesus macaque. Prophylactic remdesivir treatment initiated 24 h prior to inoculation completely prevented MERS-CoV-induced clinical disease, strongly inhibited MERS-CoV replication in respiratory tissues, and prevented the formation of lung lesions. Therapeutic remdesivir treatment initiated 12 h postinoculation also provided a clear clinical benefit, with a reduction in clinical signs, reduced virus replication in the lungs, and decreased presence and severity of lung lesions. The data presented here support testing of the efficacy of remdesivir treatment in the context of a MERS clinical trial. It may also be considered for a wider range of coronaviruses, including the currently emerging novel coronavirus 2019-nCoV.
KEYWORDS:
MERS-CoV; animal model; antiviral; remdesivir; therapy
44.
Hum Vaccin Immunother. 2020 Mar 3;16(3):736-738. doi: 10.1080/21645515.2020.1724000. Epub 2020 Feb 12.
Are we ready for the new fatal Coronavirus: scenario of Pakistan?
45.
N Engl J Med. 2020 Mar 26;382(13):1199-1207. doi: 10.1056/NEJMoa2001316. Epub 2020 Jan 29.
Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia.
Li Q1, Guan X1, Wu P1, Wang X1, Zhou L1, Tong Y1, Ren R1, Leung KSM1, Lau EHY1, Wong JY1, Xing X1, Xiang N1, Wu Y1, Li C1, Chen Q1, Li D1, Liu T1, Zhao J1, Liu M1, Tu W1, Chen C1, Jin L1, Yang R1, Wang Q1, Zhou S1, Wang R1, Liu H1, Luo Y1, Liu Y1, Shao G1, Li H1, Tao Z1, Yang Y1, Deng Z1, Liu B1, Ma Z1, Zhang Y1, Shi G1, Lam TTY1, Wu JT1, Gao GF1, Cowling BJ1, Yang B1, Leung GM1, Feng Z1.
Abstract
BACKGROUND:
The initial cases of novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP.
METHODS:
We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number.
RESULTS:
Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9).
CONCLUSIONS:
On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.).
Copyright © 2020 Massachusetts Medical Society.
Comment in
- Racing Towards the Development of Diagnostics for a Novel Coronavirus (2019-nCoV). [Clin Chem. 2020]
- Pandemic potential of 2019-nCoV. [Lancet Infect Dis. 2020]
- Covid-19 - Navigating the Uncharted. [N Engl J Med. 2020]
46.
PLoS One. 2019 Dec 27;14(12):e0227107. doi: 10.1371/journal.pone.0227107. eCollection 2019.
Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients.
Abstract
BACKGROUND:
Sputum remains the most preferred specimen for detection of Mycobacterium tuberculosis due to its non-invasive method of production. Good quality sputum specimen is essential for accurate diagnosis of pulmonary tuberculosis (PTB). It is therefore imperative to assess factors that are related to the production of sputum that is of the best quality.
OBJECTIVE:
We assessed the intrinsic and extrinsic characteristics of presumed tuberculosis patients and the quality of sputum they produced.
METHODS:
This was a cross-sectional study in which consenting enrolled presumed tuberculosis patients were subjected to medical examination and a structured questionnaire administered to collect clinical history, demographic information, environmental and behavioral characteristics. The enrolled participants were instructed on how to collect spot and morning sputum specimens for macroscopic and microscopic assessment to determine any association.
RESULTS:
A total of 309 patients were enrolled into the study with an even distribution on gender (50.5% males). Of these, 202 (65.3%) submitted both a spot and a morning specimen for analysis. On macroscopic examination, 70% spot and 68% morning sputum were characterized as good quality (Purulent/mucoid). The factors associated (p<0.05) with quality specimen included both intrinsic and extrinsic factors. The intrinsic factors included: difficulty in breathing, presence of conjunctivitis and knowledge of the disease whereas the only extrinsic factor associated with production of good quality sputum for tuberculosis diagnosis was time taken by patient to seek tuberculosis treatment after occurrence of any of the TB symptoms.
CONCLUSION:
Both intrinsic and extrinsic factors affected the quality of sputum produced by presumed tuberculosis patients. Clinical and behavioral characteristics including conjunctivitis, difficulty in breathing and delay in seeking treatment were important factors that determined the production of good quality sputum specimens, while knowledge of tuberculosis disease did not compel presumed tuberculosis patients to produce good quality sputum for diagnosis of the disease.
- PMID:
- 31881063
- PMCID:
- PMC6934296
- DOI:
- 10.1371/journal.pone.0227107
- [Indexed for MEDLINE]
47.
N Z Med J. 2019 Dec 13;132(1507):8-10.
The 1918-1919 influenza epidemic in New Zealand: end of the century reflections.
Comment on
48.
PLoS One. 2019 Dec 5;14(12):e0225700. doi: 10.1371/journal.pone.0225700. eCollection 2019.
Incidences of community onset severe sepsis, Sepsis-3 sepsis, and bacteremia in Sweden - A prospective population-based study.
Abstract
BACKGROUND:
Sepsis is a major healthcare challenge globally. However, epidemiologic data based on population studies are scarce.
METHODS:
During a 9-month prospective, population-based study, the Swedish Sepsis-2 criteria were used to investigate the incidence of community onset severe sepsis in adults aged ≥18 years (N = 2,196; mean age, 69; range, 18-102 years). All the patients who were admitted to the hospital and started on intravenous antibiotic treatment within 48 hours were evaluated. Retrospectively the incidence of sepsis according to Sepsis-3 criteria was calculated on this cohort.
RESULTS:
The annual incidence of community onset severe sepsis in adults at first admission was 276/100,000 (95% CI, 254-300). The incidence increased more than 40-fold between the youngest and the oldest age group, and was higher for men than for women. The respiratory tract was the most common site of infection (41% of cases). Using the Sepsis-3 criteria, the annual incidence of sepsis was 838/100,000 (95% CI, 798-877), which is 3-fold higher than that of severe sepsis. The main reason for the discrepancy in incidences is the more generous criteria for respiratory dysfunction used in Sepsis-3. Bacteremia was seen in 13% of all the admitted patients, giving an incidence of 203/100,000/year (95%, CI 184-223), which is among the highest incidences reported.
CONCLUSIONS:
We found a high incidence of community onset severe sepsis, albeit lower than that seen in previous Scandinavian studies. The incidence increased markedly with age of the patient. The incidence of community onset sepsis according to the Sepsis-3 definition is the highest reported to date. It is 3-fold higher than that for severe sepsis, due to more generous criteria for respiratory dysfunction. A very high incidence of bacteremia was noted, partly explained by the high frequency of blood cultures.
- PMID:
- 31805110
- PMCID:
- PMC6894792
- DOI:
- 10.1371/journal.pone.0225700
- [Indexed for MEDLINE]
49.
Environ Sci Pollut Res Int. 2020 Jan;27(2):1436-1448. doi: 10.1007/s11356-019-06805-4. Epub 2019 Nov 20.
Effect of diurnal temperature range on outpatient visits for common cold in Shanghai, China.
Abstract
To evaluate the correlations between diurnal temperature range (DTR) and the number of outpatient visits for common cold from Jan. 1, 2008, to Dec. 31, 2010, in the Shanghai metro area; we used a distributed lag non-linear model together with a Poisson regression model. The controlling factors included long-term trends and day of the week in outpatient visits for common cold and the selected weather elements. The entire study group was divided into three different age subgroups, including ≤ 15, 15-65, and ≥ 65 years old. We found some non-linear J-patterns between DTR and daily outpatient visits for common cold. At lag 0 day, the number of outpatient visits for common cold would increase by 11.1% per 1 °C increase in DTR. The greater the DTR, the more it affects outpatient visits for common cold, especially for the ≥ 65 years age group. In addition, DTR plays a more important role in outpatient visits for common cold in spring and winter compared with other seasons of the year. Our study showed that DTR is a risk factor that contributes to common cold. Results in this study can provide scientific evidence for the local authorities in improving preventive measures of the healthcare system.
KEYWORDS:
Common cold; Distributed lag non-linear model; Diurnal temperature range
50.
Ann Intern Med. 2019 Nov 19;171(10):JC52. doi: 10.7326/ACPJ201911190-052.
In inpatients with community-acquired pneumonia, a bundled intervention with steroids did not reduce length of stay.
Comment on
51.
Food Funct. 2019 Dec 11;10(12):8129-8136. doi: 10.1039/c9fo02128k.
The effects of OLL1073R-1 yogurt intake on influenza incidence and immunological markers among women healthcare workers: a randomized controlled trial.
Kinoshita T 1, Maruyama K , Suyama K , Nishijima M , Akamatsu K , Jogamoto A , Katakami K , Saito I .
Abstract
Probiotics have been expected to enhance human immune function. The aim of this study was to evaluate the effects of dietary intake of yogurt fermented with Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 (OLL1073R-1) on the prevention of influenza during winter and on the activation of immunological markers among women healthcare workers. 961 women aged 20-71 years were randomly assigned to either the yogurt group (n = 479) or the control group (n = 482). Participants in the yogurt group consumed a 112 mL yogurt drink fermented with OLL1073R-1 every day for 16 weeks, whereas those in the control group consumed no yogurt during this period. All participants were instructed not to consume any other kinds of yogurt or fermented dairy products throughout this trial. The cumulative incidence rate of influenza was measured, and immunological markers were examined at the baseline and after 16 weeks. No significant difference in the incidence rate of influenza was found between the two groups (cumulative incidence rates of flu: yogurt 7.5% and control 7.7%). Natural killer (NK) cell activity did not show a significant intervention effect (p = 0.11), whereas the intervention effect on serum interferon gamma (IFN-γ) production was significant (p = 0.03). Other immunological markers did not show significant intervention effects. Consumption of OLL1073R-1 yogurt did not show a significant preventive effect against influenza or a significant enhancement in NK cell activity. However, intake of this yogurt showed an increase in IFN-γ production.
52.
J Korean Med Sci. 2019 Nov 11;34(43):e270. doi: 10.3346/jkms.2019.34.e270.
Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea.
Heo DH#1, Seo JW#1, Kim JH1, Chun JY1, Jun KI2, Kang CK2, Moon SM1,2, Song KH1,2, Choe PG2, Park WB2, Bang JH2, Kim ES1,2, Park SW2, Kim NJ2, Oh MD2, Kim HB1,3.
Abstract
BACKGROUND:
Delays in isolating patients admitted to hospital with active pulmonary tuberculosis (PTB) can contribute to nosocomial transmission; however, in Korea, patients with clinically diagnosed PTB are not routinely isolated while awaiting microbiological confirmation of the diagnosis. We aimed to assess the extent of delays in isolating patients admitted with PTB and to identify the factors associated with delayed isolation.
METHODS:
We retrospectively reviewed the electronic medical records of patients aged ≥ 18 years with active PTB, between January 2008 and December 2017, from two Korean hospitals.
RESULTS:
Among 1,062 patients, 612 (57.6%) were not isolated on admission day. The median time from admission to isolation was 1 day (interquartile range: 0-2 days). The independent risk factor most strongly associated with delayed isolation was admission to departments other than pulmonology or infectious diseases departments (adjusted odds ratio [aOR], 5.302; 95% confidence interval [CI], 3.177-8.847; P < 0.001). Factors associated with isolation on admission day were a past history of tuberculosis (TB) (aOR, 0.669; 95% CI, 0.494-0.906; P = 0.009), night sweats (aOR, 0.530; 95% CI, 0.330-0.851; P = 0.009), and apical infiltrates on chest radiographs (aOR, 0.452; 95% CI, 0.276-0.740; P = 0.002).
CONCLUSION:
Concerning patients subsequently diagnosed with active PTB, > 50% were not isolated on admission day. We suggest that the patients with clinically suspected PTB including the elderly who have a past history of TB, night sweats, or apical infiltration on chest radiographs, be presumptively isolated on admission, without waiting for microbiological confirmation of the diagnosis.
© 2019 The Korean Academy of Medical Sciences.
KEYWORDS:
Isolation; Pulmonary Tuberculosis; Transmission
Comment in
- PMID:
- 31701700
- PMCID:
- PMC6838606
- DOI:
- 10.3346/jkms.2019.34.e270
- [Indexed for MEDLINE]
53.
Cien Saude Colet. 2019 Oct 28;24(11):4133-4140. doi: 10.1590/1413-812320182411.32402017. eCollection 2019.
[The impact of sugarcane burning on hospitalization due to respiratory diseases].
[Article in Portuguese; Abstract available in Portuguese from the publisher]
Ramos D1, Pestana PRS1, Trevisan IB1, Christofaro DGD2, Tacao GY1, Coripio IC1, Ferreira AD1, Ramos EMC1.
Abstract
The scope of this article is to evaluate the impact of emissions from sugarcane burning on hospital admission numbers for respiratory diseases in a sugarcane region. Hospital admission records for respiratory diseases were acquired from the database of the Hospital Information System of the Unified Health System (SIH-SUS) in the period from March 28, 2011 to December 28, 2012. Levels of PM10, NO2, O3, Temperature and Relative Humidity were recorded. Logistic regression models were created to analyze the association between the total number of hospitalizations, atmospheric pollutants and meteorological variables. A total of 1,179 hospitalization admissions were recorded, with a significant increase in cases of pneumonia in the burning period (p = 0.005). Likewise, it was observed that the cluster of PM10 and NO2 was influenced 67.9% (95% CI: 11.111-2.537) followed by cluster PM10, NO2, O3 and Temperature that influenced 91.1% (95% CI: 1.116; 3.271) in the total number of hospitalization admissions. During the sugarcane burning period there were more hospitalization admissions due to respiratory tract diseases, mainly pneumonia, where the influence of air pollutants and temperature in the process of illness in the population was detected.
54.
JAAPA. 2019 Oct;32(10):18-23. doi: 10.1097/01.JAA.0000580528.33851.0c.
Updated concepts in the diagnosis and management of community-acquired pneumonia.
Hunton R1.
Abstract
Pneumonia accounts for about 1 million hospitalizations each year in the United States. It is the number one cause of death from infectious disease and eighth leading cause of death in the United States. This article reviews recent updates in best practices for diagnosing and managing pneumonia in the ED or primary care practice. Despite developments in the diagnosis of pneumonia, vital signs and chest examination findings can and should guide clinical management. Chest radiography is routinely used to diagnose pneumonia. However, a negative chest radiograph should not replace clinical impression. In immunocompetent patients with community-acquired pneumonia, the CURB-65 decision rule has a role in identifying high-risk patients, including those who will require ICU admission and a critical care intervention.
55.
JAAPA. 2019 Jul;32(7):25-28. doi: 10.1097/01.JAA.0000558320.47868.2f.
An overview of reactive arthritis.
Abstract
Reactive arthritis, also known as Reiter syndrome, is a spondyloarthropathy that typically follows a urogenital or gastrointestinal infection, and is characterized by conjunctivitis, urethritis, and arthritis. The frequency of reactive arthritis in the United States is estimated at 3.5 to 5 patients per 100,000. Physician assistants (PAs) can manage the condition; therefore, they should be familiar with the disease's signs and symptoms, diagnostic criteria, and treatment regimens. Without proper management, reactive arthritis can progress to a chronic destructive arthritis. Prompt recognition of the condition is key to early intervention and a better patient outcome with fewer complications.
56.
Infect Genet Evol. 2019 Sep;73:358-361. doi: 10.1016/j.meegid.2019.05.022. Epub 2019 Jun 1.
Diagnosis and treatment of patients with pulmonary nontuberculous mycobacterial diseases in Arkhangelsk, Russia.
Abstract
BACKGROUND:
Nontuberculous mycobacteria (NTM) are acid-fast bacilli (AFB) that can cause disease in human. Patients with NTM pulmonary disease can be falsely diagnosed with pulmonary tuberculosis (TB) due detection of AFB in sputum and similar clinical and chest X-ray picture. Laboratory detection of NTM is complicated and does not always mean presence of the disease, but can be attributed to colonization or sample contamination. Molecular tests, such as Genotype Mycobacterium CM/AS, allow quick and reliable detection of NTM.
OBJECTIVE:
To assess the NTM identification rate, to estimate the incidence of pulmonary NTM disease and to report the treatment outcomes among patients with NTM disease.
DESIGN:
Retrospective cohort design.
RESULTS:
NTM were detected among 92 (0.98 per 100,000 population) presumptive pulmonary TB patients in Arkhangelsk region in 2010-2017 among who 39 (0.42 per 100,000 population) patients were diagnosed with NTM disease. The most prevalent species found in our study were M. avium (33%) and M.intracellulare (11%). 69% of patients with NTM disease completed their treatment, 15% died, 13% were lost to follow up and 3% failed treatment.
CONCLUSION:
A system of diagnostics and treatment for NTM disease was set up in the Arkhangelsk region in Russia. Average NTM identification rate and incidence of pulmonary NTM disease were 0.98 per 100,000 and 0.42 per 100,000 population accordingly and were lower than reported in other studies. Treatment success rate in our study was 69% encouraging further improvements in diagnostics and treatment of patients with NTM.
Copyright © 2019 Elsevier B.V. All rights reserved.
KEYWORDS:
Diagnostics; NTM; Nontuberculous mycobacteria; Pulmonary disease; Russian Federation; Treatment; Tuberculosis
57.
Hosp Pediatr. 2019 Jun;9(6):479-481. doi: 10.1542/hpeds.2019-0079.
A Room Without a View: Toward the Evidence.
Comment on
58.
Curr Opin Organ Transplant. 2019 Jun;24(3):311-317. doi: 10.1097/MOT.0000000000000633.
Community-acquired respiratory viruses.
Abstract
PURPOSE OF REVIEW:
Incidence of community-acquired respiratory viruses (CARVs) after lung transplantation (LTx) is 10-68 cases per 100 patient-years. Infected patients may develop graft failure and there seems to be an association between CARV infection and development of chronic lung allograft dysfunction (CLAD). This review summarizes the impact of CARV infection after LTx and potential treatment strategies.
RECENT FINDINGS:
Detection rate of CARV depends on diagnostic methods. CARV infections after LTx are reported more frequently probably attributed to improved diagnostic methods, especially nucleic acid testing. Paramyxoviridae and picornaviridae are most frequent. For paramyxoviridae, the association with CLAD is reported in various single-center observational studies. Neuraminidase inhibitors are approved for influenza and can be safely used in flu-infected LTx patients. There is no approved treatment for paramyxoviruses, most centers use ribavirin in the infected LTx recipient.
SUMMARY:
Antivirals against CARV in LTx recipients have not yet demonstrated reduced morbidity in randomized clinical trials. Agents against CARV under development are inhibiting viral attachment and use silencing mechanisms of viral replication. The cohort of lung transplant recipients is a focus of intense research because of the high morbidity of CARV infection and intense surveillance of LTx recipeints.
59.
Adv Chronic Kidney Dis. 2019 Jan;26(1):51-60. doi: 10.1053/j.ackd.2018.09.003.
Prevention and Treatment of Multidrug-Resistant Organisms in End-Stage Renal Disease.
Abstract
Chronic kidney disease patients are at high risk for infections because of multidrug-resistant organisms. Infections are the second most common cause of death in patients with ESRD. Patients with ESRD are prone to infections given alterations in immunity, increased rates of colonization with multidrug-resistant organisms, increased hospitalizations, and interactions with health care systems. Infections range from urinary tract infections, pneumonia, skin and soft tissue infections, central line-associated bloodstream infections to sepsis. A coordinated collaborative effort using a multipronged approach must be stressed to reduce the burden of infections. Preventive measures such as hand hygiene, antibiotic stewardship, immunizations, and minimizing central venous catheters are critical to curtail infections with multidrug-resistant organisms. Empirical and targeted treatment for multidrug-resistant organisms may require collaboration with infectious disease providers to improve outcomes in these serious infections. It is imperative to address multidrug-resistant organisms in ESRD patients at this juncture to improve medical outcomes now and for the future.
Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Chronic kidney disease; Infections; Multidrug resistant organisms; Prevention; Treatment
60.
Epidemiol Infect. 2019 Jan;147:e118. doi: 10.1017/S0950268818003473.
Pneumonia hospitalisation and case-fatality rates in older Australians with and without risk factors for pneumococcal disease: implications for vaccine policy.
Abstract
Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65-84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060-1122) compared with 522/100 000 (95% CI 501-545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61-22.87) vs. 6.82/100 000 (95% CI 4.56-9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.
KEYWORDS:
Australia; CAP; elderly; high risk; pneumococcal; pneumonia
- PMID:
- 30869015
- PMCID:
- PMC6518507
- DOI:
- 10.1017/S0950268818003473
- [Indexed for MEDLINE]
61.
Epidemiol Infect. 2019 Jan;147:e127. doi: 10.1017/S0950268818003424.
School sessions are correlated with seasonal outbreaks of medically attended respiratory infections: electronic health record time series analysis, Wisconsin 2004-2011.
Abstract
Increased social contact within school settings is thought to be an important factor in seasonal outbreaks of acute respiratory infection (ARI). To better understand the degree of impact, we analysed electronic health records and compared risks of respiratory infections within communities while schools were in session and out-of-session. A time series analysis of weekly respiratory infection diagnoses from 28 family medicine clinics in Wisconsin showed that people under the age of 65 experienced an increased risk of ARI when schools were in session. For children aged 5-17 years, the risk ratio for the first week of a school session was 1.12 (95% confidence interval (CI) 0.93-1.34), the second week of a session was 1.39 (95% CI 1.15-1.68) and more than 2 weeks into a session was 1.43 (95% CI 1.20-1.71). Less significant increased risk ratios were also observed in young children (0-4 years) and adults (18-64 years). These results were obtained after modelling for baseline seasonal variations in disease prevalence and controlling for short-term changes in ambient temperature and relative humidity. Understanding the mechanisms of seasonality make it easier to predict outbreaks and launch timely public health interventions.
KEYWORDS:
Influenza; respiratory infections; transmission
- PMID:
- 30868998
- PMCID:
- PMC6518471
- DOI:
- 10.1017/S0950268818003424
- [Indexed for MEDLINE]
62.
Surg Infect (Larchmt). 2019 Dec;20(8):607-610. doi: 10.1089/sur.2018.239. Epub 2019 Feb 27.
Clinical Outcome and Risk Factors for Emergency Department Adult Patients with Thoracic Empyema after Video-Assisted Thoracic Surgical Procedure.
Abstract
Background: Empyema is a purulent infection of the pleural cavity that is most relevant to parapneumonia effusion. Video-assisted thoracoscopic surgery (VATS) is an option for stage 2 (fibrinopurulent) and stage 3 (organizational). Surgeons may see critically ill patients with pleural empyema who present to the emergency department (ED). The purpose of this work is to investigate the outcomes of ED adult patients with thoracic empyema undergoing a thoracoscopic surgical procedure and to identify possible risk factors for death. Methods: We reviewed retrospectively the clinical characteristics and treatment outcomes of patients with thoracic empyema who received this diagnosis at our center from January 2012 to June 2014. Patients <20 years old were excluded from this study. The prognostic values of age, sex, comorbidities, clinical presentations, location, stage, and laboratory examinations were evaluated. Uni-variable analysis and multi-variable modeling were performed to determine significant risk factors for post-operative death. Results: Seventeen of 160 patients died post-operatively. Two groups (survivors and non-survivors) significantly differed in age (p = 0.013), sex (p = 0.026), comorbidity (p = 0.017), cough (p = 0.024), chest pain (p = 0.016), serum hemoglobin (p = 0.001), and potassium (p = 0.004) levels. Further logistic regression analysis showed statistically significant differences in age, hemoglobin levels, and potassium levels. Conclusion: Among the ED patients with thoracic empyema, older age, lower hemoglobin levels, and higher potassium levels are associated with post-operative death after VATS. These findings underline the importance of careful peri-operative treatment in older patients with signs of empyema when they present to the ED.
KEYWORDS:
age; hemoglobin; potassium; thoracic empyema video-assisted thoracoscopic surgery
63.
Sci Adv. 2019 Feb 13;5(2):eaav2554. doi: 10.1126/sciadv.aav2554. eCollection 2019 Feb.
Influenza binds phosphorylated glycans from human lung.
Byrd-Leotis L1,2, Jia N2, Dutta S2, Trost JF1, Gao C2, Cummings SF2, Braulke T3, Müller-Loennies S4, Heimburg-Molinaro J2, Steinhauer DA1, Cummings RD2.
Abstract
Influenza A viruses can bind sialic acid-terminating glycan receptors, and species specificity is often correlated with sialic acid linkage with avian strains recognizing α2,3-linked sialylated glycans and mammalian strains preferring α2,6-linked sialylated glycans. These paradigms derive primarily from studies involving erythrocyte agglutination, binding to synthetic receptor analogs or binding to undefined surface markers on cells or tissues. Here, we present the first examination of the N-glycome of the human lung for identifying natural receptors for a range of avian and mammalian influenza viruses. We found that the human lung contains many α2,3- and α2,6-linked sialylated glycan determinants bound by virus, but all viruses also bound to phosphorylated, nonsialylated glycans.
64.
J Healthc Qual Res. 2019 Jan - Feb;34(1):41-43. doi: 10.1016/j.jhqr.2018.09.006. Epub 2019 Jan 7.
[Risk of absenteeism in health personnel during a hypothetical flu pandemic].
[Article in Spanish]
65.
Hosp Pediatr. 2019 Feb;9(2):142-143. doi: 10.1542/hpeds.2018-0183. Epub 2019 Jan 3.
Intermittent Pulse Oximetry Use and Length of Stay in Bronchiolitis: Bystander or Primary Driver?
Comment on
- PMID:
- 30606775
- PMCID:
- PMC6350267
- DOI:
- 10.1542/hpeds.2018-0183
- [Indexed for MEDLINE]
66.
J Clin Microbiol. 2019 Jan 30;57(2). pii: e01717-18. doi: 10.1128/JCM.01717-18. Print 2019 Feb.
Added Value of Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting.
Abstract
Xpert MTB/RIF (Xpert) for direct molecular detection of Mycobacterium tuberculosis and rifampin resistance from clinical specimens has dramatically improved the diagnosis of tuberculosis (TB). Xpert MTB/RIF Ultra (Ultra) is proposed as a substitute of Xpert with increased sensitivity and improved rifampin resistance detection. We evaluated the diagnostic performance of Ultra and Xpert for pulmonary TB diagnosis in a low-TB-burden setting. Performance of Ultra and Xpert were compared to culture on respiratory specimens from patients with suspected pulmonary TB (November 2016 to August 2018; n = 196) in Lausanne (Switzerland). Clinical data were used to investigate discrepant results. Correlation between semiquantitative result of Ultra and smear microscopy status for the detection of acid-fast bacilli (AFB) was established. The sensitivities of Xpert and Ultra were 82.9% (39/47) and 95.8% (45/47), respectively, when considering all culture-positive specimens, 100% (23/23) for both assays on smear-positive specimens, and 66.7% (16/24) and 91.7% (22/24) on smear-negative specimens. Using culture as gold standard, the specificities of Xpert and Ultra were 97.3% (145/149) and 96.64% (144/149), respectively. All the patients with Ultra-positive results with the new category "trace" were diagnosed with active TB based on clinical findings and microbiological culture. The semiquantitative results of both Xpert and of Ultra positively correlated with the semiquantitative result of AFB detection. Our data support an increased sensitivity of Ultra compared to Xpert in a low-prevalence setting. Correlation between the Ultra semiquantitative result and AFB burden can help in evaluating a patient's transmission potential.
Copyright © 2019 Opota et al.
KEYWORDS:
Mycobacterium tuberculosis ; Xpert MTB/RIF; Xpert MTB/RIF Ultra; acid-fast bacilli; airborne isolation; clinical microbiology; diagnostic microbiology; point-of-care test; smear microscopy; tuberculosis
67.
J Clin Microbiol. 2019 Jan 30;57(2). pii: e01519-18. doi: 10.1128/JCM.01519-18. Print 2019 Feb.
Performance of RGM Medium for Isolation of Nontuberculous Mycobacteria from Respiratory Specimens from Non-Cystic Fibrosis Patients.
Rotcheewaphan S1,2, Odusanya OE1, Henderson CM1, Stephenson D3, Olivier KN4, Perry JD3, Zelazny AM5.
Abstract
A new selective medium for rapidly growing mycobacteria (RGM medium) was evaluated on respiratory specimens from non-cystic fibrosis patients and compared to the mycobacterial growth indicator tube (MGIT) system and Middlebrook 7H11 agar for the isolation of all nontuberculous mycobacteria (NTM). A total of 203 mucolyzed respiratory specimens collected from 163 patients were inoculated on RGM medium and incubated at both 30°C (RGM30) and 35°C (RGM35) over a 28-day period. N-Acetyl-l-cysteine-sodium hydroxide (NALC-NaOH)-decontaminated specimens were inoculated into MGIT and Middlebrook 7H11 agar and incubated at 35°C for 42 days. NTM were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) or gene sequencing. A total of 133 NTM isolates were recovered overall from 101 (49.8%) specimens collected from 85 (52.1%) patients by a combination of all culture methods. The sensitivity of RGM30 for the recovery of NTM was significantly higher than that of either the MGIT system (76.7% versus 59.4%; P = 0.01) or Middlebrook 7H11 agar (76.7% versus 47.4%; P = 0.0001) alone, but it was not significantly different from that of an acid-fast bacillus culture (AFC) which includes both MGIT and Middlebrook 7H11 agar (76.7% versus 63.9%; P = 0.0647). RGM35 had significantly lower sensitivity than the MGIT system (49.6% versus 59.4%; P = 0.0367) and AFC (49.6% versus 63.9%; P = 0.0023). RGM medium was highly effective at inhibiting the growth of nonmycobacterial organisms in the respiratory specimens, with breakthrough contamination rates of 5.4% and 4.4% for RGM30 and RGM35, respectively.
Copyright © 2019 American Society for Microbiology.
KEYWORDS:
MGIT; Middlebrook; Mycobacterium ; RGM; nontuberculous mycobacteria; respiratory culture; selective medium
68.
J Clin Microbiol. 2019 Jan 30;57(2). pii: e00906-18. doi: 10.1128/JCM.00906-18. Print 2019 Feb.
Mycobacterium talmoniae, a Potential Pulmonary Pathogen Isolated from Multiple Patients with Bronchiectasis in the United States, Including the First Case of Clinical Disease in a Patient with Cystic Fibrosis.
Vasireddy R#1, Vasireddy S#1, Brown-Elliott BA2, Greninger AL3, Davidson RM4, Ard KL5, Turenne CY6, Wallace RJ Jr1.
Abstract
We characterize three respiratory isolates of the recently described species Mycobacterium talmoniae recovered in Texas, Louisiana, and Massachusetts, including the first case of disease in a patient with underlying cystic fibrosis. The three isolates had a 100% match to M. talmoniae NE-TNMC-100812T by complete 16S rRNA, rpoB region V, and hsp65 gene sequencing. Core genomic comparisons between one isolate and the type strain revealed an average nucleotide identity of 99.8%. The isolates were susceptible to clarithromycin, amikacin, and rifabutin, while resistance was observed for tetracyclines, ciprofloxacin, and linezolid. M. talmoniae should be added to the list of potential pulmonary pathogens, including in the setting of cystic fibrosis.
Copyright © 2019 American Society for Microbiology.
KEYWORDS:
Mycobacterium talmoniae ; bronchiectasis; cystic fibrosis
69.
Respiration. 2019;97(2):135-144. doi: 10.1159/000493430. Epub 2018 Oct 17.
Predictors of Outcomes in Patients with Prolonged Weaning with Focus on Respiratory Tract Pathogens and Infection.
Abstract
BACKGROUND:
The impact of respiratory tract pathogens and infection on outcomes in patients with prolonged weaning is largely unknown.
OBJECTIVE:
We studied predictors of weaning outcomes (death and failure to achieve spontaneous ventilation) in a population treated during a 3.5-year period in a specialized and certified weaning centre.
METHODS:
Patient data were retrieved retrospectively from the clinical charts. Complete datasets were available in 173 patients. The following parameters were investigated as potential predictors of both endpoints: age; comorbidities; tracheobronchial pathogens; bacteraemia, pneumonia and number of pneumonias; and number of inhouse treatment cycles (none vs. ≥1).
RESULTS:
Tracheobronchial pathogens, pneumonia, bacteraemia and the number of antibiotic cycles all significantly increased weaning duration and hospitalisation times. Independent predictors of death were atrial fibrillation (OR 2.6, 95% CI 1.2-5.8, p = 0.02) and tracheobronchial multiresistant Pseudomonas aeruginosa (OR 3.9, 95% CI 1.4-11.0, p = 0.01). Independent predictors of failure to achieve spontaneous ventilation included chronic obstructive pulmonary disease (OR 2.8, 95% CI 1.0-7.8, p = 0.045); neuromuscular disease (OR 8.3, 95% CI 1.2-27.2, p = 0.02); tracheobronchial P. aeruginosa (OR 3.3, 95% CI 1.3-9.3, p = 0.01); Stenotrophomonas maltophilia (OR 7.9, 95% CI 1.4-51.6, p = 0.02); and pneumonia (OR 4.4, 95% CI 1.5-10.9, p = 0.003).
CONCLUSIONS:
The impact of respiratory tract pathogens and infection on weaning outcomes was remarkable. Predictors of death and failure to achieve spontaneous ventilation differed considerably. A priority may be to investigate preventive strategies against colonisation and infection with respiratory pathogens, particularly P. aeruginosa.
© 2018 S. Karger AG, Basel.
KEYWORDS:
Bacteremia; Pathogens; Pneumonia; Respiratory infection; Respiratory tract
70.
Respiration. 2019;97(2):153-159. doi: 10.1159/000492335. Epub 2018 Sep 11.
Incidence and Predictors of Tracheobronchial Tuberculosis in Pulmonary Tuberculosis: A Multicentre, Large-Scale and Prospective Study in Southern China.
Abstract
BACKGROUND:
Patients with pulmonary tuberculosis (PTB) have a high risk of concomitant tracheobronchial tuberculosis (TBTB), which commonly causes severe complications such as tracheobronchial stenosis. The prevalence and predictors of TBTB in China remain unclear due to the lack of prospective and large-scale studies.
OBJECTIVES:
To investigate the incidence of TBTB in PTB patients in southern China, and elucidate the predictors of TBTB and related tracheobronchial stenosis.
METHODS:
We prospectively performed bronchoscopy in PTB patients to diagnose TBTB at four medical centres in southern China from September 2015 to August 2016. Clinical and epidemiological data were recorded and analysed to determine predictors of TBTB and related tracheobronchial stenosis.
RESULTS:
A total of 345 (23.9%) of the 1,442 PTB patients undergoing bronchoscopy were diagnosed with TBTB. Female sex (OR 2.53), age < 50 years (OR 1.88), living in urban (OR 2.19), diabetes (OR 1.84), coughing (OR 2.61), and symptoms ≥4 weeks (OR 1.66) were predictors of PTB concomitant with TBTB. About 59.7% TBTB patients developed tracheobronchial stenosis, of which 23.3% cases presented severe airway narrowing. Female sex (OR 2.27), age < 50 years (OR 2.11), shortness of breath (OR 1.97), and symptoms ≥4 weeks (OR 1.71) were predictors of TBTB-related tracheobronchial stenosis.
CONCLUSIONS:
About 23.9% of PTB patients undergoing bronchoscopy present with TBTB in Guangdong province, southern China. Young and middle-aged females with symptoms persisting for ≥4 weeks (the main predictors of TBTB and related tracheobronchial stenosis) should receive bronchoscopy immediately when diagnosed with PTB.
© 2018 S. Karger AG, Basel.
KEYWORDS:
Bronchoscopy; Incidence; Predictor; Tracheobronchial stenosis; Tracheobronchial tuberculosis
71.
Ann Med. 2019 Feb;51(1):41-50. doi: 10.1080/07853890.2018.1518580. Epub 2019 Mar 23.
A new prediction model for assessing the clinical outcomes of ICU patients with community-acquired pneumonia: a decision tree analysis.
Abstract
PURPOSE:
We aimed to develop a new scoring index based on decision-tree analysis to predict clinical outcomes of patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU).
METHODS:
Data of 3519 ICU patients with CAP were obtained from the Medical Information Mart for Intensive Care III (MIMIC III) 2001-2012 database and analysed between 30-d survivors and non-survivors. Accuracy, sensitivity, and specificity of the new decision tree model were compared with those of CURB-65 and SOAR.
RESULTS:
The newly developed classification and regression tree (CART) model identified coexisting illnesses as the most important single discriminating factor between survivors and non-survivors. The CART model area under the curve (AUC) 0.661 was superior to that of CURB-65 (0.609) and SOAR (0.589). CART sensitivity was 73.4%, and specificity 49.0%. CURB-65 and SOAR sensitivity for predicting 30-d mortality were 74.5 and 80.7%, and specificity was 42.3 and 33.9%, respectively. After smoothing, the CART model had higher sensitivity and specificity than both CURB-65 and SOAR.
CONCLUSIONS:
The new CART prediction model has higher specificity and better receiver operating characteristics (ROC) curves than CURB-65 and SOAR score indices although its accuracy and sensitivity are only moderately better than the other systems. Key messages The new CART prediction model has higher specificity and better ROC curves than CURB-65 and SOAR score indices. However, accuracy and sensitivity of the new CART prediction model are only moderately better than the other systems in predicting 30-day mortality in CAP patients.
KEYWORDS:
Intensive care; community-acquired pneumonia; mortality
72.
J Trop Pediatr. 2019 Jun 1;65(3):231-239. doi: 10.1093/tropej/fmy040.
Pediatric empyema thoracis: What has changed over a decade?
Abstract
OBJECTIVES:
The purposes of this paper are to study clinicobacteriological profile, treatment modalities and outcome of pediatric empyema thoracis and to identify changes over a decade.
DESIGN:
This is a retrospective study.
SETTING:
Department of Pediatrics of a tertiary care hospital in North India.
PATIENTS:
We enrolled 205 patients (1 month-12 years) of empyema thoracis admitted over 5 years (2007-11) and compared the profile with that of a previous study from our institute (1989-98).
RESULTS:
Pleural fluid cultures were positive in 40% (n = 82) cases from whom 87 isolates were obtained. Staphylococcus aureus was the most common isolate (66.7%). Methicillin-sensitive S. aureus accounted for 56%, Methicillin-resistant S. aureus (MRSA) 10% and gram-negative organisms 18.3% of isolates. Intercostal drainage tube (ICDT) was inserted in 97.5%, intrapleural streptokinase was administered in 33.6%, and decortication performed in 27.8% cases. Duration of hospital stay was 17.2 (±6.3) days, duration of antibiotic (intravenous and oral) administration was 23.8 (±7.2) days and mortality rate was 4%. In the index study (compared with a previous study), higher proportion of cases received parenteral antibiotics (51.7% vs. 23.4%) and ICDT insertion (20.5% vs. 7%) before referral and had disseminated disease (20.5% vs. 14%) and septic shock (11.2% vs. 1.6%), less culture positivity (40% vs. 48%), more MRSA (10.3% vs. 2.5%) and gram-negative organisms (18.4% vs. 11.6%), increased use of intrapleural streptokinase and surgical interventions (27.8% vs. 19.7%), shorter hospital stay (17 vs. 25 days) and higher mortality (3.9% vs. 1.6%).
CONCLUSIONS:
Over a decade, an increase in the incidence of empyema caused by MRSA has been noticed, with increased use of intrapleural streptokinase and higher number of surgical interventions.
© The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
KEYWORDS:
MRSA; decortication; empyema; fibrinolytics
73.
J Trop Pediatr. 2019 Jun 1;65(3):224-230. doi: 10.1093/tropej/fmy037.
Underlying Diseases and Causative Microorganisms of Recurrent Pneumonia in Children: A 13-Year Study in a University Hospital.
Tural-Kara T1, Özdemir H1, Yıldız N2, Aldemir Kocabaş B1, Erat T1, Yahşi A1, Doğu F3, Tutar E4, İnce E1, Çiftçi E1.
Abstract
Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient's clinical condition and the laboratory and radiological data.
© The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
KEYWORDS:
children; recurrent pneumonia; respiratory virus; underlying disease
74.
Am J Perinatol. 2019 Jan;36(1):90-96. doi: 10.1055/s-0038-1666975. Epub 2018 Jul 9.
Outcomes of a Negative Rapid Influenza Diagnostic Test in Pregnant Women.
Abstract
OBJECTIVE:
The objective of this study was to evaluate the negative predictive value (NPV) of a rapid influenza diagnostic test (RIDT) compared with polymerase chain reaction (PCR) in pregnant women.
STUDY DESIGN:
Retrospective cohort study of pregnant women with a negative RIDT followed by confirmatory PCR for influenza A, H1N1, and B during the influenza seasons from 2012 to 2015.
RESULTS:
The NPV of the RIDT was 85.4% (211 of 247), 93.5% (231 of 247), and 97.9% (242 of 247) for influenza A, H1N1, and B, respectively. Antiviral treatment was administered to 47.2% (17 of 36) of women with a false-negative RIDT for influenza A compared with 9.0% (19 of 211) of women with a true-negative RIDT (p< 0.001). Patients were more likely to receive antiviral treatment if they were feverish (adjusted odds ratio [aOR]: 6.05, 95% confidence interval [CI]: 1.83-20.03), had cough (aOR: 6.43, 95% CI: 1.06-39.26), dyspnea (aOR: 6.41, 95% CI: 1.63-25.29), or had a subsequently positive PCR (aOR: 9.41, 95% CI: 3.13-28.31).
CONCLUSION:
Up to 14.5% of women with a negative RIDT in pregnancy had positive influenza A by PCR of whom more than half did not receive antiviral treatment.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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