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Bronowicka-Szydełko A, Lewandowski Ł, Lubieniecki P, Adamiec-Mroczek J, Doroszko A, Trocha M, Kujawa K, Matera-Witkiewicz A, Rabczyński M, Kuźnik E, Madziarski M, Sokołowski J, Jankowska EA, Madziarska K. Pre-hospital oxygen therapy and saturation variability in COVID-19 patients with and without glucose metabolism disorders: part of the COLOS Study. Sci Rep 2024; 14:19286. [PMID: 39164354 PMCID: PMC11335941 DOI: 10.1038/s41598-024-70240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
The COVID-19 pandemic has revealed that viruses can have multiple receptor properties, penetrating various tissues and causing mutations in various genes, thus promoting a range of metabolic disorders. The purpose of this study was to investigate the connection between three factors: diabetic status, pre-hospitalization oxygen therapy, and saturation levels, to the values of morphological, inflammatory, and biochemical parameters in the blood serum of COVID-19 patients. The study group consisted of 2139 patients, 1076 women (50.30%) and 1063 men (49.70%), with an average age of 63.73 ± 15.69 years. The population was divided into three groups based on a three-stage scale, taking into account patients with either type 2 diabetes/prediabetes (473 patients), those who received oxygen therapy before hospitalization, and those with a saturation value of below 95% (cut-off value). Among patients who did not receive pre-hospitalization oxygen therapy, those with diabetes and a SpO2 level < 95% had significantly higher levels of D-dimers, procalcitonin, albumin, lymphocytes, RDW-SD ≥ 47, potassium, creatinine, and troponin T when compared to diabetic patients with a SpO2 level ≥ 95%. Similarly, in the same group of patients without pre-hospitalization oxygen therapy, those without diabetes but with a SpO2 level < 95% showed significantly increased levels of IL-6, CRP, albumin, lymphocytes, RDW-SD ≥ 47, glucose, potassium, sodium, creatinine, and ALT, compared to patients without diabetes and with a SpO2 level ≥ 95%. The findings suggest that lower saturation levels may result in increased potassium and glucose levels in patients who did not receive any oxygen therapy before hospitalization due to COVID-19. It is hypothesized that this may be caused by damage to pancreatic β-cells by SARS-CoV-2, and disturbances in the potassium channel, leading to cell membrane depolarization and insulin secretion.
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Affiliation(s)
- Agnieszka Bronowicka-Szydełko
- Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Chałubińskiego St.10, 50-368, Wrocław, Poland
| | - Łukasz Lewandowski
- Department of Biochemistry and Immunochemistry, Wroclaw Medical University, Chałubińskiego St.10, 50-368, Wrocław, Poland
| | - Pawel Lubieniecki
- Clinical Department of Diabetology and Internal Disease, Faculty of Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland.
| | - Joanna Adamiec-Mroczek
- Clinical Department of Ophthalmology, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Adrian Doroszko
- Clinical Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Małgorzata Trocha
- Clinical Department of Diabetology and Internal Disease, Faculty of Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Krzysztof Kujawa
- Statistical Analysis Centre, Wroclaw Medical University, K. Marcinkowski St. 2-6, 50-368, Wroclaw, Poland
| | - Agnieszka Matera-Witkiewicz
- Screening of Biological Activity Assays and Collection of Biological Material Laboratory, Faculty of Pharmacy, Wroclaw Medical University Biobank, Wroclaw Medical University, Borowska St. 221A, 50-556, Wroclaw, Poland
| | - Maciej Rabczyński
- Clinical Department of Diabetology and Internal Disease, Faculty of Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Edwin Kuźnik
- Clinical Department of Diabetology and Internal Disease, Faculty of Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Marcin Madziarski
- Clinical Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Janusz Sokołowski
- Department of Emergency Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
| | - Katarzyna Madziarska
- Clinical Department of Diabetology and Internal Disease, Faculty of Medicine, Wroclaw Medical University, Borowska St. 213, 50-556, Wroclaw, Poland
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Jamalidoust M, Eilami O, Ashkan Z, Ziyaeyan M, Aliabadi N, Habibi M. The rates and symptoms of natural and breakthrough infection pre- and post- Covid-19 non-mRNA vaccination at various peaks amongst Iranian healthcare workers. Virol J 2023; 20:182. [PMID: 37596593 PMCID: PMC10436397 DOI: 10.1186/s12985-023-02156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND/AIMS The aim of this study was to determine the rate of natural and breakthrough infection and related symptoms of Covid-19 amongst Iranian healthcare workers (HCWs) who were vaccinated by different non-mRNA-based vaccines at peak points. METHODS In this cross-sectional study, the RT-PCR test was performed for a total of 10,581 HCWs suspicious of Covid-19 infection. For each HCW, the frequency of SARS-CoV-2 infection and the time of transmission based on vaccination administration time and schedule were examined during different waves of the pandemic. Based on these findings, the study patients were divided into three groups: natural, natural/breakthrough, and breakthrough. RESULTS In total, 53% of the HCWs were exposed to SARS-CoV-2 infection between 1 and 5 times within two years after the current pandemic, while 20.7% and 32.3% experienced natural and breakthrough SARS-CoV-2 infection, respectively. Only 6% of the breakthrough-infected HCWs had naturally contracted SARS-CoV-2 infection during the initial waves. The highest natural peaks of infection occurred during the interval administration of the first and second dose of the first vaccination series, while the single highest peak of breakthrough infection belonged to the Omicron wave. It occurred simultaneously with the administration of the third vaccination dose. On the other hand, the highest rate of reinfection was observed amongst people who had received the Sinopharm and Bharat vaccines full-doses. CONCLUSION This study compared the clinical differences between the two peaks of Omicron and Delta. This study indicates the rates of natural and breakthrough SARS-CoV-2 infections according to vaccination schedules and different waves of the pandemic.
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Grants
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz- Iran
- Department of Family Medicine and infectious disease, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Biology, Faculty of Basic Science, Shahrekord University, Shahrekord, Iran.
- Statistics and Information Technology Management, Shiraz University of Medical Sciences, Shiraz, Iran
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Affiliation(s)
- Marzieh Jamalidoust
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran.
| | - Owrang Eilami
- Department of Family Medicine and Infectious Disease, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Ashkan
- Department of Biology, Faculty of Basic Science, Shahrekord University, Shahrekord, Iran
| | - Mazyar Ziyaeyan
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran
| | - Nasrin Aliabadi
- Department of Virology, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran
| | - Mohammad Habibi
- Statistics and Information Technology Management, Shiraz University of Medical Sciences, Shiraz, Iran
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Ukwishaka J, Ndayishimiye Y, Destine E, Danwang C, Kirakoya-Samadoulougou F. Global prevalence of coronavirus disease 2019 reinfection: a systematic review and meta-analysis. BMC Public Health 2023; 23:778. [PMID: 37118717 PMCID: PMC10140730 DOI: 10.1186/s12889-023-15626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/07/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged with a high transmissibility rate and resulted in numerous negative impacts on global life. Preventive measures such as face masks, social distancing, and vaccination helped control the pandemic. Nonetheless, the emergence of SARS-CoV-2 variants, such as Omega and Delta, as well as coronavirus disease 2019 (COVID-19) reinfection, raise additional concerns. Therefore, this study aimed to determine the overall prevalence of reinfection on global and regional scales. METHODS A systematic search was conducted across three databases, PubMed, Scopus, and ProQuest Central, including all articles pertaining to COVID-19 reinfection without language restriction. After critical appraisal and qualitative synthesis of the identified relevant articles, a meta-analysis considering random effects was used to pool the studies. RESULTS We included 52 studies conducted between 2019 and 2022, with a total sample size of 3,623,655 patients. The overall prevalence of COVID-19 reinfection was 4.2% (95% confidence interval [CI]: 3.7-4.8%; n = 52), with high heterogeneity between studies. Africa had the highest prevalence of 4.7% (95% CI: 1.9-7.5%; n = 3), whereas Oceania and America had lower estimates of 0.3% (95% CI: 0.2-0.4%; n = 1) and 1% (95% CI: 0.8-1.3%; n = 7), respectively. The prevalence of reinfection in Europe and Asia was 1.2% (95% CI: 0.8-1.5%; n = 8) and 3.8% (95% CI: 3.4-4.3%; n = 43), respectively. Studies that used a combined type of specimen had the highest prevalence of 7.6% (95% CI: 5.8-9.5%; n = 15) compared with those that used oropharyngeal or nasopharyngeal swabs only that had lower estimates of 6.7% (95% CI: 4.8-8.5%; n = 8), and 3.4% (95% CI: 2.8-4.0%; n = 12) respectively. CONCLUSION COVID-19 reinfection occurs with varying prevalence worldwide, with the highest occurring in Africa. Therefore, preventive measures, including vaccination, should be emphasized to ensure control of the pandemic.
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Affiliation(s)
- Joyeuse Ukwishaka
- Maternal Child and Community Health Division, Rwanda Bio-Medical Center, Kigali, Rwanda.
- IntraHealth International, Kigali, Rwanda.
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
| | - Yves Ndayishimiye
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Esmeralda Destine
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Qureshi AI, Baskett WI, Huang W, Akinci Y, Suri MFK, Naqvi SH, French BR, Siddiq F, Gomez CR, Shyu CR. New cardiovascular events in the convalescent period among survivors of SARS-CoV-2 infection. Int J Stroke 2023; 18:437-444. [PMID: 35796639 PMCID: PMC10037124 DOI: 10.1177/17474930221114561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have an increased risk of acute cardiovascular events in the convalescent period. AIMS To determine whether patients with SARS-CoV-2 infection have an increased risk of cardiovascular events during the convalescent period. METHODS We analyzed 10,691 hospitalized adult pneumonia patients with SARS-CoV-2 infection and contemporary matched controls of pneumonia patients without SARS-CoV-2 infection. The risk of new cardiovascular events following >30 days pneumonia admission (convalescent period) was ascertained using Cox proportional hazards regression analysis to adjust for potential confounders. RESULTS Among 10,691 pneumonia patients with SARS-CoV-2 infection, 697 patients (5.8%; 95% CI, 5.4-6.2%) developed new cardiovascular events (median time interval of 218 days post pneumonia admission; interquartile range Q1 = 117 days, Q3 = 313 days). The risk of new cardiovascular events was not significantly higher among pneumonia patients with SARS-CoV-2 infection compared with those with pneumonia without SARS-CoV-2 infection (hazard ratio (HR), 0.90, 95% CI, 0.80-1.02) after adjustment for potential confounders. In addition, no significant difference in the rate of a new ischemic stroke (HR, 0.84; 95% CI, 0.70-1.02) or ischemic heart disease (HR, 1.00; 95% CI, 0.87-1.15) was observed between the pneumonia patients with and without SARS-CoV-2 infection. CONCLUSION Our study suggests that new cardiovascular events rate in the convalescent period among pneumonia patients with SARS-CoV-2 infection was not significantly higher than the rate seen with other pneumonias.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - William I Baskett
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Wei Huang
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Yasemin Akinci
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | | | - S Hasan Naqvi
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Brandi R French
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Farhan Siddiq
- Division of Neurosurgery, University of Missouri, Columbia, MO, USA
| | - Camilo R Gomez
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
- Department of Medicine, University of Missouri, Columbia, MO, USA
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
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Piazza MF, Amicizia D, Marchini F, Astengo M, Grammatico F, Battaglini A, Sticchi C, Paganino C, Lavieri R, Andreoli GB, Orsi A, Icardi G, Ansaldi F. Who Is at Higher Risk of SARS-CoV-2 Reinfection? Results from a Northern Region of Italy. Vaccines (Basel) 2022; 10:vaccines10111885. [PMID: 36366393 PMCID: PMC9692964 DOI: 10.3390/vaccines10111885] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
The SARS-CoV-2 pandemic continues to spread worldwide, generating a high impact on healthcare systems. The aim of the study was to examine the epidemiological burden of SARS-CoV-2 reinfections and to identify potential related risk factors. A retrospective observational study was conducted in Liguria Region, combining data from National Vaccines Registry and Regional Chronic Condition Data Warehouse. In the study period (September 2021 to May 2022), 335,117 cases of SARS-CoV-2 infection were recorded in Liguria, of which 15,715 were reinfected once. During the Omicron phase (which predominated from 3 January 2022), the risk of reinfection was 4.89 times higher (p < 0.001) than during the Delta phase. Unvaccinated and vaccinated individuals with at least one dose for more than 120 days were at increased risk of reinfection compared with vaccinated individuals with at least one dose for ≤120 days, respectively (odds ratio (OR) of 1.26, p < 0.001; OR of 1.18, p < 0.001). Healthcare workers were more than twice as likely to be reinfected than non-healthcare workers (OR of 2.38, p < 0.001). Lower ORs were seen among people aged 60 to 79 years. Two doses or more of vaccination were found to be protective against the risk of reinfection rather than a single dose (mRNA vaccines: OR of 0.06, p < 0.0001, and OR of 0.1, p < 0.0001; vector vaccines: OR of 0.05, p < 0.0001). Patients with chronic renal failure, cardiovascular disease, bronchopneumopathy, neuropathy and autoimmune diseases were at increased risk of reinfection (OR of 1.38, p = 0.0003; OR of 1.09, p < 0.0296; OR of 1.14, p = 0.0056; OR of 1.78, p < 0.0001; OR of 1.18, p = 0.0205). Estimating the epidemiological burden of SARS-CoV-2 reinfections and the role played by risk factors in reinfections is relevant for identifying risk-based preventive strategies in a pandemic context characterized by a high circulation of the virus and a high rate of pathogen mutations.
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Affiliation(s)
- Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
- Correspondence: ; Tel.: +39-010-548-4680
| | - Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Francesca Marchini
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Matteo Astengo
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
| | - Federico Grammatico
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Alberto Battaglini
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Camilla Sticchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
| | - Chiara Paganino
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
| | - Rosa Lavieri
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
| | | | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy
| | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
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Gambhir RP, Parthasarathy AK, Sharma S, Kale S, Magdum VV, Tiwari AP. pH-responsive glycine functionalized magnetic iron oxide nanoparticles for SARS-CoV-2 RNA extraction from clinical sample. JOURNAL OF MATERIALS SCIENCE 2022; 57:13620-13631. [PMID: 35855687 PMCID: PMC9281320 DOI: 10.1007/s10853-022-07464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED The recent outbreak of the novel corona virus disease 2019 (COVID-19) has been made a serious global impact due to its high infectivity and severe symptoms. The Severe Acute Respiratory Syndrome (SARS-CoV-2) RNA extraction is considered as one of the most important steps in COVID-19 detection. Several commercially available kits and techniques are currently being used for specific extraction of SARS-CoV-2 RNA. However, such methods are time consuming and expensive due to the requirement of trained labors, and several chemical reagents. To overcome the mentioned limitations, magnetic RNA adsorption methodology of glycine functionalized iron oxide nanoparticles (GNPs) was established. It showed an efficient potential in SARS-CoV-2 RNA extraction due to pH responsive nature of GNPs. The highly magnetic pH responsive GNPs were synthesized by one-pot co-precipitation method. Random morphology and average 20 nm size of GNPs were denoted by Transmission Electron Microscopy (TEM). X-ray diffractometer (XRD) showed the crystalline magnetite nature. Fourier transform infrared spectroscopy (FT-IR) and UV-visible spectrometry confirmed the presence of glycine on the surface of magnetic nanoparticles. Furthermore, the magnetic nature and thermal properties of GNPs were examined by vibrating sample magnetometer (VSM) and thermo-gravimetric analysis (TGA), respectively. In this study, glycine performed the role of RNA adsorbent. The adsorption of RNA onto the surface of GNPs was achieved in acidic medium (pH 6). In contrary, the elution of RNA from the surface of GNPs was achieved in basic medium (pH 8). The purity of obtained RNA was analyzed by UV-visible spectrometry. Further, the obtained RNA was examined for the presence of SARS-CoV-2 specific Envelope (E), RNA dependent RNA polymerase (RDRP) and Nucleocapsid (N) genes using an RT-PCR analysis. It showed the sudden rise in amount of these genes after 25 cycles of RT-PCR and hence indicated the efficient RNA extraction by GNPs. Agarose gel electrophoresis was used for validation of the quantity and quality of RNA extracted from SARS-CoV-2 patient's sample. The reusability studies of GNPs were performed by monitoring the repeated use of GNPs for SARS-CoV-2 RNA extraction. This method possesses potential role in the field of disease diagnosis. The extraction results of RNA from SARS-CoV-2 patient's sample indicated that the GNPs have an outstanding property over the current existing extraction protocols. It leads to the new advancements in extraction and detection of RNA. GRAPHICAL ABSTRACT Graphical abstract of the pH responsive SARS-CoV-2 RNA extraction by using glycine functionalized magnetic iron oxide nanoparticles (GNPs) which were prepared by modified cost effective one pot chemical synthesis method. Prepared GNPs were characterized by XRD, FT-IR and UV-Visible spectrometry, Scanning electron microscopy (SEM) and Transmission electron microscopy (TEM). Glycine present on the surface of nanoparticles (NPs) played an important role in pH responsive RNA extraction procedure. When nanoparticles added in acidic (pH < 7) medium, glycine gained positive surface charge hence overall surface charge of NPs became positive. Thereby SARS-CoV-2 RNA adsorption/binding occurred on the surface of GNP. Later, the RNA-GNP complex was separated by an external magnet. Separated complex was added in basic (pH > 7) medium to elute RNA from GNP. This phenomenon occurred due to surface negative charge of glycine that caused charge repulsion with RNA. Eluted RNA was examined qualitatively and quantitatively by RT-PCR, nanodrop technique and agarose gel electrophoresis. Results were compared with kit based extracted RNA. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10853-022-07464-6.
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Affiliation(s)
- Rutuja Prashant Gambhir
- Department of Stem Cell and Regenerative Medicine, Centre for Interdisciplinary Science, D.Y. Patil Education Society, Kolhapur, India
| | | | - Shimpa Sharma
- D.Y. Patil Medical College and Hospital, Kolhapur, India
| | - Shital Kale
- Department of Materials Science and Engineering, Chonnam National University, Gwangju, South Korea
| | - Vikas Vijay Magdum
- Centre for Interdisciplinary Science, D.Y. Patil Education Society, Kolhapur, India
| | - Arpita Pandey Tiwari
- Department of Stem Cell and Regenerative Medicine, Centre for Interdisciplinary Science, D.Y. Patil Education Society, Kolhapur, India
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Chivese T, Matizanadzo JT, Musa OAH, Hindy G, Furuya-Kanamori L, Islam N, Al-Shebly R, Shalaby R, Habibullah M, Al-Marwani TA, Hourani RF, Nawaz AD, Haider MZ, Emara MM, Cyprian F, Doi SAR. The prevalence of adaptive immunity to COVID-19 and reinfection after recovery - a comprehensive systematic review and meta-analysis. Pathog Glob Health 2022; 116:269-281. [PMID: 35099367 PMCID: PMC9248963 DOI: 10.1080/20477724.2022.2029301] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This study aims to estimate the prevalence and longevity of detectable SARS-CoV-2 antibodies and T and B memory cells after recovery. In addition, the prevalence of COVID-19 reinfection and the preventive efficacy of previous infection with SARS-CoV-2 were investigated. A synthesis of existing research was conducted. The Cochrane Library, the China Academic Journals Full Text Database, PubMed, and Scopus, and preprint servers were searched for studies conducted between 1 January 2020 to 1 April 2021. Included studies were assessed for methodological quality and pooled estimates of relevant outcomes were obtained in a meta-analysis using a bias adjusted synthesis method. Proportions were synthesized with the Freeman-Tukey double arcsine transformation and binary outcomes using the odds ratio (OR). Heterogeneity was assessed using the I2 and Cochran's Q statistics and publication bias was assessed using Doi plots. Fifty-four studies from 18 countries, with around 12,000,000 individuals, followed up to 8 months after recovery, were included. At 6-8 months after recovery, the prevalence of SARS-CoV-2 specific immunological memory remained high; IgG - 90.4% (95%CI 72.2-99.9, I2 = 89.0%), CD4+ - 91.7% (95%CI 78.2-97.1y), and memory B cells 80.6% (95%CI 65.0-90.2) and the pooled prevalence of reinfection was 0.2% (95%CI 0.0-0.7, I2 = 98.8). Individuals previously infected with SARS-CoV-2 had an 81% reduction in odds of a reinfection (OR 0.19, 95% CI 0.1-0.3, I2 = 90.5%). Around 90% of recovered individuals had evidence of immunological memory to SARS-CoV-2, at 6-8 months after recovery and had a low risk of reinfection.RegistrationPROSPERO: CRD42020201234.
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Affiliation(s)
- Tawanda Chivese
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar,CONTACT Tawanda Chivese ; Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Joshua T. Matizanadzo
- Department of Public Health and Primary Care, Brighton and Sussex Medical School, UK
| | - Omran A. H. Musa
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - George Hindy
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, Australia
| | - Nazmul Islam
- Department of Public Health, Qu Health, Qatar University, Doha, Qatar
| | - Rafal Al-Shebly
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Rana Shalaby
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Mohammad Habibullah
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Talal A. Al-Marwani
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Rizeq F. Hourani
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Ahmed D. Nawaz
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Mohammad Z. Haider
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Mohamed M. Emara
- Immunology Section, Basic Medical Sciences Department, College of Medicine, Qu Health, Qatar University, Doha, Qatar,Microbiology Section, Biomedical and Pharmaceutical Research Unit, Qu Health, Qatar University, Doha, Qatar
| | - Farhan Cyprian
- Immunology Section, Basic Medical Sciences Department, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Suhail A. R. Doi
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
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Toro-Huamanchumo C, Hilario-Gomez M, Pinedo-Castillo L, Zumarán-Nuñez C, Espinoza-Gonzales F, Caballero-Alvarado J, Rodriguez-Morales A, Barboza J. Clinical and epidemiological features of patients with COVID-19 reinfection: a systematic review. New Microbes New Infect 2022; 48:101021. [PMID: 36060548 PMCID: PMC9420201 DOI: 10.1016/j.nmni.2022.101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Recurrent positivity in a patient with COVID-19 may be due to various reasons, not necessarily reinfection. There is concern about the occurrence frequency of reinfection. Five databases and a preprint/preprint repository were searched. All case reports, case series, and observational studies were included. Bias was assessed for each study with the Newcastle-Ottawa Scale tool and reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA-2020). After eligibility, 77 studies were included for qualitative synthesis (52 case reports, 21 case series, and four case-controls; 1131 patients included). Of these, 16 studies described a second contact with the SARS-CoV-2 positive case, five studies described healthcare profession-related infection, ten studies described that the source of reinfection was likely to be from the community, one study described travel-related infection, nine studies described vulnerability-related infection due to comorbidity. The mean number of days from discharge or negative test to reinfection ranged from 23.3 to 57.6 days across the different included studies. The risk of bias for all case report/series studies was moderate/high. For observational studies, the risk of bias was low. Reinfection of patients with COVID-19 occurs between the first and second month after the first infection, but beyond, and 90 days have been proposed as a point to begin to consider it. The main factor for reinfection is contact with COVID-19 positive cases.
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Affiliation(s)
| | - M.M. Hilario-Gomez
- Sociedad científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
| | - L. Pinedo-Castillo
- Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
| | - C.J. Zumarán-Nuñez
- Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
| | - F. Espinoza-Gonzales
- Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Escuela Profesional de Medicina Humana de la Universidad Señor de Sipán, Chiclayo, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
| | - J. Caballero-Alvarado
- Escuela de Medicina, Universidad Privada Antenor Orrego, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
| | - A.J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
- Universidad Cientifica del Sur, Lima, Peru
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9
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Peng Y, Wang S, Chai R, Chen Y, Li N, Zeng B, Tang Q, Zheng K, Liang Y, Xie S, Huang W, Wang S, Wang X. Clinical and Gene Features of SARS-CoV-2-Positive Recurrence in Patients Recovered From COVID-19. Front Mol Biosci 2022; 9:875418. [PMID: 35755819 PMCID: PMC9217101 DOI: 10.3389/fmolb.2022.875418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/22/2022] [Indexed: 01/08/2023] Open
Abstract
There are still frequent reports that a number of recovered coronavirus disease 2019 (COVID-19) patients following discharge have re-detectable positive (RP) results by RT-PCR. Understanding the clinical and molecular characteristics of RP patients may have implications for curbing the COVID-19 pandemic. In this study, 318 COVID-19 convalescent patients, including 59 RP patients and 259 non-RP (NRP) patients, were enrolled. Among RP patients, women accounted for a significantly high proportion (67.8%), and the titers of IgG and IgM antibodies in this group were also significantly high. Differentially expressed genes (DEGs), including 692 upregulated and 383 downregulated genes, overlapped in two public GEO datasets containing RP and NRP blood cell samples. Enrichment analysis indicated that these DEGs were related to several key signaling pathways, such as viral infection, immune activation, and inflammatory responses. Importantly, 59 indicator genes constituting the core network exhibited high diagnostic values and were correlated with markers of different immune cells. Among these, 12 drug-related genes were associated with the RP results. Our work suggests that, in addition to clinically available features, blood cell transcriptome sequencing can be performed to obtain gene signatures for diagnosis of RP patients.
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Affiliation(s)
- Yuying Peng
- Department of Pharmacy, Shenzhen Key Laboratory of Prevention and Treatment of Severe Infection, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.,School of Pharmacy, Jinan University, Guangzhou, China
| | - Shaoqi Wang
- Department of Internal Medicine, Hubei Province Corps Hospital of The Chinese Armed Police Force (CAPF), Wuhan, China
| | - Ruihuan Chai
- School of Pharmaceutical Sciences, Shenzhen University Health Science Center, Shenzhen, China
| | - Yong Chen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Nan Li
- School of Pharmaceutical Sciences, Shenzhen University Health Science Center, Shenzhen, China
| | - Boning Zeng
- Department of Pharmacy, Shenzhen Key Laboratory of Prevention and Treatment of Severe Infection, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Qian Tang
- Department of Pharmacy, Shenzhen Key Laboratory of Prevention and Treatment of Severe Infection, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.,School of Pharmacy, Jinan University, Guangzhou, China
| | - Kai Zheng
- School of Pharmaceutical Sciences, Shenzhen University Health Science Center, Shenzhen, China
| | - Youfang Liang
- School of Pharmaceutical Sciences, Shenzhen University Health Science Center, Shenzhen, China
| | - Shouxia Xie
- Department of Pharmacy, Shenzhen Key Laboratory of Prevention and Treatment of Severe Infection, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Wei Huang
- Bacteriology and Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Shaoxiang Wang
- School of Pharmaceutical Sciences, Shenzhen University Health Science Center, Shenzhen, China
| | - Xiao Wang
- Department of Pharmacy, Shenzhen Key Laboratory of Prevention and Treatment of Severe Infection, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.,School of Pharmacy, Jinan University, Guangzhou, China
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10
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Li Y, Hu J, Wang Y, Liu D, Shi Y, Zhang J, Liu Y, Lin D, Lin J, Hu W, He H, Wang W, Fan W, Li L, Wang D, Wang K, Xu J. T-Cell Repertoire Characteristics of Asymptomatic and Re-Detectable Positive COVID-19 Patients. Front Immunol 2022; 12:769442. [PMID: 35154070 PMCID: PMC8828559 DOI: 10.3389/fimmu.2021.769442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/24/2021] [Indexed: 01/01/2023] Open
Abstract
The prevention of the COVID-19 pandemic is highly complicated by the prevalence of asymptomatic and recurrent infection. Many previous immunological studies have focused on symptomatic and convalescent patients, while the immune responses in asymptomatic patients and re-detectable positive cases remain unclear. Here we comprehensively analyzed the peripheral T-cell receptor (TCR) repertoire of 54 COVID-19 patients in different courses, including asymptomatic, symptomatic, convalescent, and re-detectable positive cases. We identified a set of V-J gene combinations characterizing the upward immune responses through asymptomatic and symptomatic courses. Furthermore, some of these V-J combinations could be awakened in the re-detectable positive cases, which may help predict the risk of recurrent infection. Therefore, TCR repertoire examination has the potential to strengthen the clinical surveillance and the immunotherapy development for COVID-19.
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Affiliation(s)
- Yizhe Li
- Department of Laboratory Medicine, Shunde Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Jian Hu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongsi Wang
- Department of Translational Medicine Research Institute, Guangzhou Huayin Medical Laboratory Center Ltd., Guangzhou, China
| | - Dongdong Liu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaling Shi
- Department of Laboratory Medicine, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jiaqi Zhang
- Department of Laboratory Medicine, Shunde Hospital of Guangzhou University of Chinese Medicine, Foshan, China
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuntao Liu
- Emergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dongzi Lin
- Department of Laboratory Medicine, The Fourth People’s Hospital of Foshan, Foshan, China
| | - Jing Lin
- Department of Clinical Laboratory, The First People’s Hospital of Foshan, Foshan, China
| | - Wei Hu
- Department of Laboratory Medicine, Shunde Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Haolan He
- Department of Infectious Diseases, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Department of Laboratory Medicine, The Fourth People’s Hospital of Foshan, Foshan, China
| | - Wentao Fan
- Department of Translational Medicine Research Institute, Guangzhou Huayin Medical Laboratory Center Ltd., Guangzhou, China
| | - Linlin Li
- Department of Translational Medicine Research Institute, Guangzhou Huayin Medical Laboratory Center Ltd., Guangzhou, China
| | - Dawei Wang
- Department of Pulmonary and Critical Care Medicine, Shunde Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Kejian Wang
- The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, China
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianhua Xu
- Department of Laboratory Medicine, Shunde Hospital of Guangzhou University of Chinese Medicine, Foshan, China
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11
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Joshi R, Singla R, Mishra A, Kumar M, Singh RS, Singh A, Bansal S, Sharma AR, Sarma P, Prakash A, Medhi B. A systematic review on SARS-CoV-2 remission: an Emerging challenge for its management, treatment, immunization strategies and post-treatment guidelines. New Microbes New Infect 2022; 45:100949. [PMID: 35018221 PMCID: PMC8739778 DOI: 10.1016/j.nmni.2022.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/12/2021] [Accepted: 01/04/2022] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 disease caused by severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2) has posed as a major health concern for people all across the globe. Along with the increasing confirmed patients being readmitted with complaints for fever, cough, cold, the effective monitoring of 'relapse' of the SARS-CoV-2 virus in the previously discharged patients have become the next area of focus. However, availability of limited data on reactivation of SARS-CoV-2 makes the disease prognosis as well as the effective control of re-infection an immense challenge. Prompted by these challenges, we assessed the possibility of re-infection in discharged patients and the risk of the transmission, proficiency of RT-PCR results and approximate period required for the quarantine and the real challenges for the development of vaccine. In the present review, the published literature on all the possible cases of re-infection from February to July were reported, thereby selected 142 studies from a hub of overall 669 studies after full text screening. The incomplete virus clearance, poor sensitivity of the present diagnostic testing, emergence of mutant strains, insufficient mucus collection from the throat swab etc. are some of the possible causes of re-infection. The new protocols for management of COVID-19 discharged patients should be revised in the guidelines.
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Affiliation(s)
- Rupa Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Rubal Singla
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Abhishek Mishra
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Mukesh Kumar
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Rahul Soloman Singh
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Ashutosh Singh
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Seema Bansal
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Amit Raj Sharma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Phulen Sarma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Ajay Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh
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12
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Sotoodeh Ghorbani S, Taherpour N, Bayat S, Ghajari H, Mohseni P, Hashemi Nazari SS. Epidemiologic characteristics of cases with reinfection, recurrence, and hospital readmission due to COVID-19: A systematic review and meta-analysis. J Med Virol 2022; 94:44-53. [PMID: 34411311 PMCID: PMC8427032 DOI: 10.1002/jmv.27281] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023]
Abstract
Recent studies reported that some recovered COVID-19 patients have tested positive for virus nucleic acid again. A systematic search was performed in Web of Science, PubMed, Scopus, and Google Scholar up to March 6, 2021. The pooled estimation of reinfection, recurrence, and hospital readmission among recovered COVID-19 patients was 3, 133, and 75 per 1000 patients, respectively. The overall estimation of reinfection among males compared to females was greater. The prevalence of recurrence in females compared to males was more common. Also, hospital readmission between sex groups was the same. There is uncertainty about long-term immunity after SARS-Cov-2 infection. Thus, the possibility of reinfection and recurrence after recovery is not unexpected. In addition, there is a probability of hospital readmission due to adverse events of COVID-19 after discharge. However, with mass vaccination of people and using the principles of prevention and appropriate management of the disease, frequent occurrence of the disease can be controlled.
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Affiliation(s)
- Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Niloufar Taherpour
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Sahar Bayat
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Hadis Ghajari
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Parisa Mohseni
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Saeed Hashemi Nazari
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
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13
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Li S, Wang X, Li L, Pan Y, Yang S, Tan D, Shen Y, Yang P, Bar-Zeev N, Hu Y, Jennings JM, Li S, Wang L, Wang Q. Factors Associated with SARS-CoV-2 Repeat Positivity — Beijing, China, June–September 2020. China CDC Wkly 2022; 4:88-95. [PMID: 35186376 PMCID: PMC8837463 DOI: 10.46234/ccdcw2022.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Repeat positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) following COVID-19 initial viral clearance (re-positivity) poses a public health management challenge. The objective was to determine factors associated with neutralizing antibody (Nab) level and re-positivity among patients infected with a single strain SARS-CoV-2. Methods During a single strain SARS-CoV-2 cluster in Beijing, China, longitudinal individual clinical, virological, and immunological data were collected from 368 infections from June 13 to September 22, 2020. Factors associated with Nab level and re-positivity were analyzed using generalized estimating equations. Results A total of 353 (96%) SARS-CoV-2 infections had demographic, clinical, and laboratory data available. Among the 353 infections, 55 (15.5%) were re-positive, and blood draws were taken from 346 individuals (98.0%) during hospitalization and/or during the follow-up period. Symptoms were milder for the second-time admission for the re-positives, although 36.4% of re-positives presented with radiographic appearance of pneumonia manifestation. Compared to non-re-positive patients, NAb titers were lower among re-positives; NAb was positively associated with clinical severity. Samples from the lower respiratory tract manifested higher viral load than that from the upper respiratory tract. Multivariable analysis showed re-positivity was positively associated with being female [odd ratio (OR)=1.7, 95% confidence interval (CI) 1.1–2.8] and being aged <18 years (OR=5.2, 95% CI 1.5–18.1); having initially asymptomatic infection (OR=13.7, 95% CI 1.6–116.3); and negatively associated with a higher NAb level (OR=0.9, 95% CI 0.5–1.7). Conclusions NAb may be important for sustained viral clearance. Lower respiratory tract infection was associated with higher viral load among all infections when compared to upper respiratory tract infection. Continuous lower respiratory and intermittent upper respiratory viral shedding among COVID-19 infections may occur.
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Affiliation(s)
- Siqi Li
- Beijing Center for Disease Prevention and Control, Beijing, China
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaoli Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- School of Public Health, Capital Medical University, Beijing, China
| | - Li Li
- Emergency department of Infectious diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yang Pan
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- School of Public Health, Capital Medical University, Beijing, China
| | - Siyuan Yang
- Laboratory of Infectious Diseases Center of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Dawei Tan
- Emergency department of Infectious diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Peng Yang
- Beijing Center for Disease Prevention and Control, Beijing, China
- School of Public Health, Capital Medical University, Beijing, China
| | - Naor Bar-Zeev
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yaling Hu
- Sinovac Biotech Co, Ltd, Beijing, China
| | - Jacky M. Jennings
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Simin Li
- Yiducloud (Beijing) Technology Co., Ltd, Beijing, China
| | - Linghang Wang
- Emergency department of Infectious diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Quanyi Wang,
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- School of Public Health, Capital Medical University, Beijing, China
- Linghang Wang,
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14
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Zhang MM, Chen LN, Qian JM. Gastrointestinal manifestations and possible mechanisms of COVID-19 in different periods. J Dig Dis 2021; 22:683-694. [PMID: 34738727 PMCID: PMC8652439 DOI: 10.1111/1751-2980.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a pandemic worldwide. Although COVID-19 mainly affects the respiratory system, gastrointestinal (GI) manifestations have been frequently reported in such cases, even as initial symptoms. There have been several studies on different GI manifestations in patients with mild and severe disease or in remission. In this review article we summarized different GI manifestations of COVID-19 at various disease stages and the possible mechanisms based on published literatures, as well as the significance of GI manifestations in systemic inflammatory injury.
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Affiliation(s)
- Meng Meng Zhang
- Department of GastroenterologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lu Ni Chen
- Department of Microbiology and Tumor and Cell BiologyKarolinska InstituteSolnaSweden
| | - Jia Ming Qian
- Department of GastroenterologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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15
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Dhillon RA, Qamar MA, Gilani JA, Irfan O, Waqar U, Sajid MI, Mahmood SF. The mystery of COVID-19 reinfections: A global systematic review and meta-analysis. Ann Med Surg (Lond) 2021; 72:103130. [PMID: 34900250 PMCID: PMC8642249 DOI: 10.1016/j.amsu.2021.103130] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND As the COVID-19 pandemic rages on, reports on disparities in vaccine roll out alongside COVID-19 reinfection have been emerging. We conducted a systematic review to assess the determinants and disease spectrum of COVID-19 reinfection. MATERIALS AND METHODS A comprehensive search covering relevant databases was conducted for observational studies reporting Polymerase Chain Reaction (PCR) confirmed infection and reinfection cases. A quality assessment tool developed by the National Institute of Health (NIH) for the assessment of case series was utilized. Meta-analyses were performed using RevMan 5.3 for pooled proportions of findings in first infection and reinfection with a 95% confidence interval (CI). RESULTS Eighty-one studies reporting 577 cases were included from 22 countries. The mean age of patients was 46.2 ± 18.9 years and 179 (31.0%) cases of comorbidities were reported. The average time duration between first infection and reinfection was 63.6 ± 48.9 days. During first infection and reinfection, fever was the most common symptom (41.4% and 36.4%, respectively) whilst anti-viral therapy was the most common treatment regimen administered (44.5% and 43.0%, respectively). Comparable odds of symptomatic presentation and management were reported for the two infections. However, a higher Intensive Care Unit (ICU) admission rate was observed in reinfection compared to first infection (10 vs 3). Ten deaths were reported with respiratory failure being the most common cause of death (7/10 deaths). CONCLUSION Our findings support immunization practices given increased ICU admissions and mortality in reinfections. Our cohort serves as a guide for clinicians and authorities in devising an optimal strategy for controlling the pandemic. (249 words).
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Affiliation(s)
| | | | | | - Omar Irfan
- Amaris Consulting, Toronto, Ontario, Canada
| | - Usama Waqar
- Medical College, Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Syed Faisal Mahmood
- Section of Infectious Diseases, Aga Khan University, Karachi, Sindh, Pakistan
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16
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Paybast S, Shahrab F, Hejazi SA. Recurrence of COVID-19 in a Patient With NMO Spectrum Disorder While Treating With Rituximab: A Case Report and Review of the Literature. Neurologist 2021; 26:281-283. [PMID: 34734909 PMCID: PMC8575111 DOI: 10.1097/nrl.0000000000000371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In the context of coronavirus disease 2019 (COVID-19) pandemic, patients with neuromyelitis optica spectrum disorder (NMOSD) are vulnerable to develop COVID-19 due to the immunosuppressive therapy. The objective of this study is to describe a known case of NMOSD on rituximab who experienced 2 episodes of COVID-19. CASE REPORT A 25-year-old woman, a known case of NMOSD on rituximab was diagnosed with asymptomatic COVID-19. Eight months later, following her last infusion of rituximab, she developed moderate COVID-19. After a partial recovery, she exhibited exacerbation of respiratory symptoms leading to readmission and invasive oxygenation. She was eventually discharged home after 31 days. Her monthly neurological evaluation did not reveal evidence of disease activity. She later received intravenous immunoglobulin and the decision was made to start rituximab again. CONCLUSIONS Our case raises the possibility of persistent virus shedding and reactivation of severe acute respiratory syndrome coronavirus-2 in a patient with NMOSD and rituximab therapy. We aimed to emphasize a precise consideration of management of patients with NMOSD during the COVID-19 pandemic.
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Affiliation(s)
| | - Fereshteh Shahrab
- Neurology Department, Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
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17
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Zhang S, Zhu H, Ye H, Hu Y, Zheng N, Huang Z, Xiong Z, Fu L, Cai T. Risk factors for prolonged virus shedding of respiratory tract and fecal in adults with severe acute respiratory syndrome coronavirus-2 infection. J Clin Lab Anal 2021; 35:e23923. [PMID: 34390043 PMCID: PMC8418473 DOI: 10.1002/jcla.23923] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The dynamic alteration and comparative study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding pattern during treatment are limited. This study explores the potential risk factors influencing prolonged viral shedding in COVID-19. METHODS A total of 126 COVID-19 patients were enrolled in this retrospective longitudinal study. A multivariate logistic regression analysis was carried out to estimate the potential risk factors. RESULTS 38.1% (48/126) cases presented prolonged respiratory tract viral shedding, and 30 (23.8%) cases presented prolonged rectal swab viral shedding. Obesity (OR, 3.31; 95% CI, 1.08-10.09), positive rectal swab (OR, 3.43; 95% CI, 1.53-7.7), treatment by lopinavir/ritonavir with chloroquine phosphate (OR, 2.5; 95% CI, 1.04-6.03), the interval from onset to antiviral treatment more than 7 days (OR, 2.26; 95% CI, 1.04-4.93), lower CD4+ T cell (OR, 0.92; 95% CI, 0.86-0.99) and higher NK cells (OR, 1.11; 95% CI, 1.02-1.20) were significantly associated with prolonged respiratory tract viral shedding. CD3-CD56+ NK cells (OR, 0.87; 95% CI, 0.76-0.99) were related with prolonged fecal shedding. CONCLUSIONS Obesity, delayed antiviral treatment, and positive SARS-CoV-2 for stool were independent risk factors for prolonged SARS-CoV-2 RNA shedding of the respiratory tract. A combination of LPV/r and abidol as the initial antiviral regimen was effective in shortening the duration of viral shedding compared with LPV/r combined with chloroquine phosphate. CD4+ T cell and NK cells were significantly associated with prolonged viral shedding, and further studies are to be warranted to determine the mechanism of immunomodulatory response in virus clearance.
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Affiliation(s)
- Shun Zhang
- Department of Experimental Medical ScienceHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
| | - Hui Zhu
- Department of Experimental Medical ScienceHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
| | - Honghua Ye
- Department of CardiologyHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
| | - Yaoren Hu
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
- Department of Infection and HepatologyHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
| | - Nanhong Zheng
- Department of Infection and HepatologyHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
| | - Zuoan Huang
- Department of Experimental Medical ScienceHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
| | - Zi Xiong
- Department of Experimental Medical ScienceHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
| | - Liyun Fu
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
- Department of Infection and HepatologyHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
| | - Ting Cai
- Department of Experimental Medical ScienceHwaMei HospitalUniversity of Chinese Academy of SciencesNingboChina
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingboChina
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18
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Zaffina S, Lanteri P, Gilardi F, Garbarino S, Santoro A, Vinci MR, Carsetti R, Scorpecci A, Raponi M, Magnavita N, Camisa V. Recurrence, Reactivation, or Inflammatory Rebound of SARS-CoV-2 Infection With Acute Vestibular Symptoms: A Case Report and Revision of Literature. Front Hum Neurosci 2021; 15:666468. [PMID: 34456694 PMCID: PMC8385757 DOI: 10.3389/fnhum.2021.666468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases.
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Affiliation(s)
- Salvatore Zaffina
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Lanteri
- Department of Diagnostics and Applied Technology, Neurophysiopathology Centre, Fondazione IRCCS, Istituto Neurologico “Carlo Besta”, Milan, Italy
| | | | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Genoa, Italy
| | - Annapaola Santoro
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Rosaria Vinci
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Carsetti
- Department of Laboratories, Unit of Diagnostic Immunology and Immunology Research Area, Unit of B-Cell Pathophysiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Scorpecci
- Audiology and Otosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Nicola Magnavita
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Camisa
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
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19
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Tang X, Musa SS, Zhao S, He D. Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. Front Public Health 2021; 9:663045. [PMID: 34178920 PMCID: PMC8226004 DOI: 10.3389/fpubh.2021.663045] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022] Open
Abstract
As the pandemic continues, individuals with re-detectable positive (RP) SARS-CoV-2 viral RNA among recovered COVID-19 patients have raised public health concerns. It is imperative to investigate whether the cases with re-detectable positive (RP) SARS-CoV-2 might cause severe infection to the vulnerable population. In this work, we conducted a systematic review of recent literature to investigate reactivation and reinfection among the discharged COVID-19 patients that are found positive again. Our study, consisting more than a total of 113,715 patients, indicates that the RP-SARS-CoV-2 scenario occurs plausibly due to reactivation, reinfection, viral shedding, or testing errors. Nonetheless, we observe that previously infected individuals have significantly lower risk of being infected for the second time, indicating that reactivation or reinfection of SARS-CoV-2 likely have relatively less impact in the general population than the primary infection.
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Affiliation(s)
- Xiujuan Tang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Salihu S Musa
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China.,Department of Mathematics, Kano University of Science and Technology, Wudil, Nigeria
| | - Shi Zhao
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China
| | - Daihai He
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China
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20
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Wang X, Chen L, Huang J, Pan J, Huang M, Chen L. Comparison of the clinical characteristics of patients with novel coronavirus pneumonia between China and overseas. J Clin Lab Anal 2021; 35:e23811. [PMID: 34080711 PMCID: PMC8209900 DOI: 10.1002/jcla.23811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To explore the clinical manifestation, imaging examination, and serology of patients with novel coronavirus pneumonia (COVID-19) between China and overseas. METHODS Ninety patients with COVID-19 who admitted to Fuzhou Pulmonary Hospital from January 23, 2020, to May 1, 2020, were included in this retrospective study. They were divided into domestic group and overseas group according to the origin regions. The clinical manifestations, imaging examination, serology, treatment, and prognosis between the two groups were compared and analyzed. RESULTS The clinical manifestations of patients in the two groups mainly included fever (83.1% and 47.4%), cough (62% and 31.6%), expectoration (47.9% and 31.6%), anorexia (28.2% and 47.4%), fatigue (21.1% and 10.5%), and dyspnea (22.5% and 0%). The main laboratory characteristics in the two groups were decreased lymphocyte count, increased lactate dehydrogenase, decreased oxygenation index, decreased white blood cell count, increased erythrocyte sedimentation rate (ESR), and increased C-reactive protein. The computed tomography (CT) examinations of chest showed bilateral and peripheral involvement, with multiple patch shadows and ground glass shadows. However, pleural effusions were rare. CONCLUSION Fever, cough, and dyspnea are more common in domestic cases than overseas cases. However, patients with COVID-19 from overseas may have the symptoms of loss of taste and smell that domestic cases do not have.
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Affiliation(s)
- Xinhang Wang
- Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
| | - Lulu Chen
- Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
| | - Jinbao Huang
- Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
| | - Jianguang Pan
- Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
| | - Mingxiang Huang
- Department of Clinical Laboratory, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
| | - Lizhou Chen
- Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
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21
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Zhang L, Liu M, Li J, Li X, Cheng L, Ji Y, Li N, Wang J. Clinical Characteristics of Foreign-Imported COVID-19 Cases in Xi'an, China. Int J Gen Med 2021; 14:2069-2078. [PMID: 34079347 PMCID: PMC8164692 DOI: 10.2147/ijgm.s315159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background Effective management of foreign-imported COVID-19 cases is a new and great challenge for China. Our study focused on the foreign-imported COVID-19 cases to provide detailed data for insights into the prevention, early diagnosis, treatment and control of imported COVID-19. Methods For this observational and retrospective study, we investigated the clinical characteristics of imported COVID-19 cases that were confirmed by real-time RT-PCR in the Xi’an Public Health Center from 29 March 2020 to 31 August 2020. Results Of the 79 patients with COVID-19, 19 (24.1%) had exposure to confirmed COVID-19 patients, 15 (19.0%) had exposure to suspicious COVID-19 patients, and 45 (56.9%) had an unclear history of exposure to confirmed patients. The mean age of the patients was 38 years, and 70 (88.7%) patients were male. Except for 2 severe cases, the remaining 58 (73.4%) cases displayed mild or moderate symptoms, and 19 (24.2%) infected patients were asymptomatic. Twenty-one (26.6%) patients were not diagnosed until a third or later nucleic acid test. Ten (12.7%) patients had chronic diseases. The most common manifestations of the patients were cough [18 (22.8%) cases], fever [9 (11.4%) cases] and sore throat [9 (11.4%) cases]. Forty-one (51.9%) cases showed abnormal chest CT images, To date, all patients have been discharged, and no patient has died. Conclusion The imported COVID-19 cases in Xi’an were mainly young and middle-aged adults with mild or moderate symptoms who had a low rate of comorbidity, showed favourable laboratory and chest CT images, and had a better prognosis. Notably, for suspected COVID-19 cases, at least three consecutive nucleic acid tests should be carried out to avoid missed detection of infected patients. Except for severe cases, high-level medical resources are not necessary in most cases.
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Affiliation(s)
- Li Zhang
- Department of Intensive Care Unit, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China.,Xi'an Public Health Center, Xi'an, Shaanxi, 710200, People's Republic of China
| | - Minjie Liu
- Xi'an Public Health Center, Xi'an, Shaanxi, 710200, People's Republic of China.,Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Jianying Li
- Xi'an Public Health Center, Xi'an, Shaanxi, 710200, People's Republic of China.,The Department of Respiratory Medicine, Xi'an Central Hospital, The Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, 710003, People's Republic of China
| | - Xiaoli Li
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Li Cheng
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Yahong Ji
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Na Li
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Junning Wang
- Xi'an Public Health Center, Xi'an, Shaanxi, 710200, People's Republic of China.,Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
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22
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Serum antibody response in COVID-19-recovered patients who retested positive. ACTA ACUST UNITED AC 2021; 47:195-201. [PMID: 34035665 DOI: 10.14745/ccdr.v47i04a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Research studies comparing antibody response from coronavirus disease 2019 (COVID-19) cases that retested positive (RP) using reverse transcription polymerase chain reaction (RT-PCR) and those who did not retest positive (NRP) were used to investigate a possible relationship between antibody response and retesting status. Methods Seven data bases were searched. Research criteria included cohort and case-control studies, carried out worldwide and published before September 9, 2020, that compared the serum antibody levels of hospitalized COVID-19 cases that RP after discharge to those that did NRP. Results There is some evidence that immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in RP cases were lower compared with NRP cases. The hypothesis of incomplete clearance aligns with these findings. The possibility of false negative reverse transcription polymerase chain reaction (RT-PCR test results during viral clearance is also plausible, as concentration of the viral ribonucleic acid (RNA) in nasopharyngeal and fecal swabs fluctuate below the limits of RT-PCR detection during virus clearance. The probability of reinfection was less likely to be the cause of retesting positive because of the low risk of exposure where cases observed a 14 day-quarantine after discharge. Conclusion More studies are needed to better explain the immune response of recovered COVID-19 cases retesting positive after discharge.
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23
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Zhu SF, Sun B, Li JK, Cai Y, Li PF, Hong JC, Li JH, Xu SW, Li XY, Xue CW, Gu BB, Wu JF, Zhou XB, Suo H, Duan PL, Wu XX, Li SW. Prediction of Re-positivity for Coronavirus Nucleic Acid Among COVID-19 Patients in the Recovery Phase. Front Med (Lausanne) 2021; 8:620727. [PMID: 34026776 PMCID: PMC8131547 DOI: 10.3389/fmed.2021.620727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Although the pathogenesis and treatment of coronavirus disease 2019 (COVID-19) have been gradually revealed, the risk for re-emergence of coronavirus nucleic acids in recovered patients remains poorly understood. Hence, this study evaluated the risk predictors associated with re-positivity for virus nucleic acid. Methods: Between February 1 and March 20, 2020, we retrospectively reviewed the clinical epidemiological data of 129 COVID-19 patients who were treated at Zhongxiang People's Hospital of Hubei Province in China. Subsequently, a risk prediction model for the re-positivity of virus nucleic acid was developed, and a receiver operating characteristic (ROC) curve was drawn for further validation. Results: In this study, the rate of re-positivity for virus nucleic acid was 17.8% (23/129) where all re-positivity cases were asymptomatic. The median time interval from discharge to nucleic acid re-positivity to discharge after being cured again was 11.5 days (range: 7-23 days). Multivariate logistic regression analysis showed that leukocytopenia [odds ratio (OR) 7.316, 95% confidence interval (CI) 2.319-23.080, p = 0.001], prealbumin < 150 mg/L (OR 4.199, 95% CI 1.461-12.071, p = 0.008), and hyperpyrexia (body temperature >39°C, OR 4.643, 95% CI 1.426-15.117, p = 0.011) were independent risk factors associated with re-positivity. The area under the ROC curve was 0.815 (95% CI, 0.729-0.902). Conclusion: COVID-19 patients with leukocytopenia, low prealbumin level, and hyperpyrexia are more likely to test positive for virus nucleic acid after discharge. Timely and effective treatment and appropriate extension of hospital stays and quarantine periods may be feasible strategies for managing such patients.
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Affiliation(s)
- Shu-fen Zhu
- Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Bo Sun
- Department of Brain Surgery, Zhongxiang People's Hospital, Jinmen, China
| | - Jin-kuang Li
- Department of Radiology, Zhongxiang People's Hospital, Jinmen, China
| | - Yue Cai
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Peng-fei Li
- Inner Mongolia People's Hospital, Hohhot, China
| | - Ji-chang Hong
- Department of Critical Care Medicine, Zhongxiang People's Hospital, Jinmen, China
| | - Jin-hai Li
- Department of Neurology, Zhongxiang People's Hospital, Jinmen, China
| | - Shi-wen Xu
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | | | | | - Bin-bin Gu
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Jian-fen Wu
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Xian-bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Hong Suo
- Department of Respiratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Pei-lin Duan
- Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xin-xin Wu
- Inner Mongolia Medical University, Hohhot, China
| | - Shao-wei Li
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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24
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Piri SM, Edalatfar M, Shool S, Jalalian MN, Tavakolpour S. A systematic review on the recurrence of SARS-CoV-2 virus: frequency, risk factors, and possible explanations. Infect Dis (Lond) 2021; 53:315-324. [PMID: 33508989 PMCID: PMC7852280 DOI: 10.1080/23744235.2020.1871066] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Since late 2019, SARS-CoV-2 which leads to coronavirus disease 2019 (COVID-19), has caused thousands of deaths. There are some pieces of evidence that SARS-CoV-2 genome could be re-detectable in recovered patients. METHODS We performed a systematic review in the PubMed/Medline database to address the risk of SARS-CoV-2 recurrence. The last update was for 20 November 2020. Among the 1178 initially found articles, 66 met the inclusion criteria and were considered. FINDINGS In total, 1128 patients with at least one-time recurrence of SARS-CoV-2 were included. Recurrence rate has been reported between 2.3% and 21.4% in cohort studies, within a mean of 20 (ranged 1-98) days after discharge; younger patients are being affected more. Following the second course of disease, the disease severity decreased or remained unchanged in 97.3% while it increased in 2.6%. Anti-SARS-CoV-2 IgG and IgM were positive in 11-95% and 58.8-100%, respectively. Based on the literature, three possibilities include reactivation of previous disease, reinfection with the same virus, and false negative, which have been discussed in details. CONCLUSION There is a relatively notable risk of disease recurrence in previously recovered patients, even those who are immunised against the virus. More studies are required to clarify the underlying cause of this phenomenon.
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Affiliation(s)
- Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Edalatfar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Shool
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Soheil Tavakolpour
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA,CONTACT Soheil Tavakolpour Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Elshazli RM, Kline A, Elgaml A, Aboutaleb MH, Salim MM, Omar M, Munshi R, Mankowski N, Hussein MH, Attia AS, Toraih EA, Settin A, Killackey M, Fawzy MS, Kandil E. Gastroenterology manifestations and COVID-19 outcomes: A meta-analysis of 25,252 cohorts among the first and second waves. J Med Virol 2021; 93:2740-2768. [PMID: 33527440 PMCID: PMC8014082 DOI: 10.1002/jmv.26836] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/09/2021] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
A meta-analysis was performed to identify patients with coronavirus disease 2019 (COVID-19) presenting with gastrointestinal (GI) symptoms during the first and second pandemic waves and investigate their association with the disease outcomes. A systematic search in PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE was performed up to July 25, 2020. The pooled prevalence of the GI presentations was estimated using the random-effects model. Pairwise comparison for the outcomes was performed according to the GI manifestations' presentation and the pandemic wave of infection. Data were reported as relative risk (RR), or odds ratio and 95% confidence interval. Of 125 articles with 25,252 patients, 20.3% presented with GI manifestations. Anorexia (19.9%), dysgeusia/ageusia (15.4%), diarrhea (13.2%), nausea (10.3%), and hematemesis (9.1%) were the most common. About 26.7% had confirmed positive fecal RNA, with persistent viral shedding for an average time of 19.2 days before being negative. Patients presenting with GI symptoms on admission showed a higher risk of complications, including acute respiratory distress syndrome (RR = 8.16), acute cardiac injury (RR = 5.36), and acute kidney injury (RR = 5.52), intensive care unit (ICU) admission (RR = 2.56), and mortality (RR = 2.01). Although not reach significant levels, subgroup-analysis revealed that affected cohorts in the first wave had a higher risk of being hospitalized, ventilated, ICU admitted, and expired. This meta-analysis suggests an association between GI symptoms in COVID-19 patients and unfavorable outcomes. The analysis also showed improved overall outcomes for COVID-19 patients during the second wave compared to the first wave of the outbreak.
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Affiliation(s)
- Rami M. Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical TherapyHorus University ‐ EgyptNew DamiettaEgypt
| | - Adam Kline
- School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Abdelaziz Elgaml
- Department of Microbiology and Immunology, Faculty of PharmacyMansoura UniversityMansouraEgypt
- Department of Microbiology and Immunology, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
| | - Mohamed H. Aboutaleb
- Department of Pharmaceutical Chemistry, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
| | - Mohamed M. Salim
- Department of Pharmaceutical Chemistry, Faculty of PharmacyHorus University ‐ EgyptNew DamiettaEgypt
- Department of Pharmaceutical Analytical Chemistry, Faculty of PharmacyMansoura UniversityMansouraEgypt
| | - Mahmoud Omar
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Ruhul Munshi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | | | - Mohammad H. Hussein
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Abdallah S. Attia
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Eman A. Toraih
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
- Genetics Unit, Histology and Cell Biology Department, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Ahmad Settin
- Pediatrics and Genetics Department, Faculty of MedicineMansoura UniversityMansouraEgypt
| | - Mary Killackey
- Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Department of Biochemistry, College of MedicineNorthern Border UniversityArarSaudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of MedicineTulane UniversityNew OrleansLouisianaUSA
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26
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Immunoglobulin Response and Prognostic Factors in Repeated SARS-CoV-2 Positive Patients: A Systematic Review and Meta-Analysis. Viruses 2021; 13:v13050809. [PMID: 33946311 PMCID: PMC8146492 DOI: 10.3390/v13050809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
With repeated positivity being an undiscovered and major concern, we aimed to evaluate which prognostic factors may impact repeated SARS-CoV-2 positivity (RSP) and their association with immunoglobulin detectability among recovered patients. A systematic literature search was performed on 5 April 2021. Cohort studies with risk factors for repeated RSP or information about the immunoglobulin response (immunoglobulin M (IgM) and/or immunoglobulin G (IgG)) were included in this analysis. The main examined risk factors were severity of the initial infection, body mass index (BMI), length of hospitalization (LOH), age, and gender, for which we pooled mean differences and odds ratios (ORs). Thirty-four cohort studies (N = 9269) were included in our analysis. We found that increased RSP rate might be associated with IgG positivity; IgG presence was higher in RSP patients (OR: 1.72, CI: 0.87–3.41, p = 0.117). Among the examined risk factors, only mild initial disease course showed a significant association with RSP (OR: 0.3, CI: 0.14–0.67, p = 0.003). Age, male gender, BMI, LOH, and severity of the first episode do not seem to be linked with repeated positivity. However, further prospective follow-up studies focusing on this topic are required.
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27
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Konstantinou F, Skrapari I, Bareta E, Bakogiannis N, Papadopoulou AM, Bakoyiannis C. A Case of SARS-CoV-2 Clinical Relapse after 4 Negative RT-PCR Tests in Greece: Recurrence or Reinfection? CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211009813. [PMID: 33911911 PMCID: PMC8047947 DOI: 10.1177/11795476211009813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2 pandemic is the greatest public health concern of the year 2020. There are several worldwide reports of patients who have managed to recover from SARS-CoV-2 infection with negative PCR test results, that for unknown reasons convert back to positive PCR. We report a case of a patient in our hospital who developed positive PCR test results for SARS-CoV-2, after 4 consecutive results that were negative, along with a full-blown clinical syndrome of SARS-CoV-2 infection.
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Affiliation(s)
- Fotis Konstantinou
- First Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Ioanna Skrapari
- First Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Eleni Bareta
- First Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | | | | | - Chris Bakoyiannis
- First Department of Surgery, Laikon General Hospital, Athens, Greece
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Ren X, Ren X, Lou J, Wang Y, Huang Q, Shi Y, Deng Y, Li X, Lu L, Yan S, Wang Y, Luo L, Zeng X, Yao X, Jin Y. A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR. EClinicalMedicine 2021; 34:100839. [PMID: 33898952 PMCID: PMC8052132 DOI: 10.1016/j.eclinm.2021.100839] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND With the increased number of patients discharged after having COVID-19, more and more studies have reported cases whose retesting was positive (RP) during the convalescent period, which brings a new public health challenge to the world. METHODS We searched PubMed, Web of Science, The Cochrane Library, CNKI, WanFang and VIP from December 1, 2019 to December 31, 2020. The included studies were assessed using JBI critical appraisal tools and Newcastle-Ottawa Scale. The RP rate of discharge patients was analyzed by a meta-analysis. We adhered to PRISMA reporting guideline. FINDINGS We have included 117 studies with 2669 RP participants after discharge. The methodological quality of 66 case reports were low to high, 42 case series and 3 cohort study were moderate to high, 3 case-control studies were moderate and 3 cross-sectional studies were low to moderate. The clinical manifestations of most RP patients were mild or asymptomatic, and CT imaging and laboratory examinations were usually normal. The existing risk factors suggest that more attention should be paid to sever patients, elderly patients, and patients with co-morbidities. The summary RP rate was 12·2% (95% CI 10·6-13·7) with high heterogeneity (I2 = 85%). INTERPRETATION To date, the causes and risk factors of RP result in discharged patients are not fully understood. High-quality etiological and clinical studies are needed to investigate these issues to further help us to make strategies to control and prevent its occurrence.
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Affiliation(s)
- Xiangying Ren
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- College of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Xiangge Ren
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jiaao Lou
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- College of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Yongbo Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuexian Shi
- School of Nursing, Peking University, Beijing, China
| | - Yuqing Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Thyroid Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Nephrology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liye Lu
- Yongnian District maternity and childcare hospital, Xinming Road No.28. Yongnian District, HanDan, Hebei, China
| | - Siyu Yan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yunyun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lisha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiantao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaomei Yao
- Center for clinical practice guideline conduction and evaluation, Children's Hospital of Fudan University, Shanghai, China
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Abstract
Background: Previous studies reported the recurrence of coronavirus disease 2019 (COVID-19) among discharge patients. This study aimed to examine the characteristic of COVID-19 recurrence cases by performing a systematic review and meta-analysis. Methods: A systematic search was performed in PubMed and Embase and gray literature up to September 19, 2020. A random-effects model was applied to obtain the pooled prevalence of disease recurrence among recovered patients and the prevalence of subjects underlying comorbidity among recurrence cases. The other characteristics were calculated based on the summary data of individual studies. Results: A total of 41 studies were included in the final analysis, we have described the epidemiological characteristics of COVID-19 recurrence cases. Of 3,644 patients recovering from COVID-19 and being discharged, an estimate of 15% (95% CI, 12% to 19%) patients was re-positive with SARS-CoV-2 during the follow-up. This proportion was 14% (95% CI, 11% to 17%) for China and 31% (95% CI, 26% to 37%) for Korea. Among recurrence cases, it was estimated 39% (95% CI, 31% to 48%) subjects underlying at least one comorbidity. The estimates for times from disease onset to admission, from admission to discharge, and from discharge to RNA positive conversion were 4.8, 16.4, and 10.4 days, respectively. Conclusion: This study summarized up-to-date evidence from case reports, case series, and observational studies for the characteristic of COVID-19 recurrence cases after discharge. It is recommended to pay attention to follow-up patients after discharge, even if they have been in discharge quarantine.
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Wu X, Wang Z, He Z, Li Y, Wu Y, Wang H, Liu Y, Hao F, Tian H. A follow-up study shows that recovered patients with re-positive PCR test in Wuhan may not be infectious. BMC Med 2021; 19:77. [PMID: 33715626 PMCID: PMC7956402 DOI: 10.1186/s12916-021-01954-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/01/2021] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Previous studies showed that recovered coronavirus disease 2019 (COVID-19) patients can have a subsequent positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after they are discharged from the hospital. Understanding the epidemiological characteristics of recovered COVID-19 patients who have a re-positive test is vital for preventing a second wave of COVID-19. METHODS This retrospective study analyzed the epidemiological and clinical features of 20,280 COVID-19 patients from multiple centers in Wuhan who had a positive PCR test between December 31, 2019, and August 4, 2020. The RT-PCR test results for 4079 individuals who had close contact with the re-positive cases were also obtained. RESULTS In total, 2466 (12.16%) of the 20,280 patients had a re-positive SARS-CoV-2 PCR test after they were discharged from the hospital, and 4079 individuals had close contact with members of this patient group. All of these 4079 individuals had a negative SARS-CoV-2 PCR test. CONCLUSIONS This retrospective study in Wuhan analyzed the basic characteristics of recovered COVID-19 patients with re-positive PCR test and found that these cases may not be infectious.
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Affiliation(s)
- Xiaomin Wu
- Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Zengmiao Wang
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China.
| | - Zhenyu He
- Wuhan Center for Disease Control and Prevention, Wuhan, China.
| | - Yapin Li
- Central Theater Center for Disease Control and Prevention of PLA, Beijing, China
| | - Yating Wu
- Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Huaiji Wang
- Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Yonghong Liu
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China
| | - Fanghua Hao
- Central China Normal University, Wuhan, China
| | - Huaiyu Tian
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China
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Adrielle Dos Santos L, Filho PGDG, Silva AMF, Santos JVG, Santos DS, Aquino MM, de Jesus RM, Almeida MLD, da Silva JS, Altmann DM, Boyton RJ, Alves Dos Santos C, Santos CNO, Alves JC, Santos IL, Magalhães LS, Belitardo EMMA, Rocha DJPG, Almeida JPP, Pacheco LGC, Aguiar ERGR, Campos GS, Sardi SI, Carvalho RH, de Jesus AR, Rezende KF, de Almeida RP. Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers. J Infect 2021; 82:399-406. [PMID: 33589297 PMCID: PMC7880834 DOI: 10.1016/j.jinf.2021.01.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term. METHODS Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation >14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database. RESULTS Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p <0.0001)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19 (2.4 ± 0.610; p<0.0001) and after recurrence (6.4 ± 11.34; p = 0.007). Virus genome sequencing identified reinfection by a different isolate in one patient. CONCLUSIONS This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.
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Affiliation(s)
- Letícia Adrielle Dos Santos
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Pedro Germano de Góis Filho
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Ana Maria Fantini Silva
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - João Victor Gomes Santos
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Douglas Siqueira Santos
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Marília Marques Aquino
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Rafaela Mota de Jesus
- Division of Pulmonology, Institute of Health Promotion and Assistance for Employees of the State of Sergipe (IPESAÚDE), Sergipe, Brazil
| | - Maria Luiza Dória Almeida
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - João Santana da Silva
- Fiocruz - Bi-Institutional Translational Medicine Project, Ribeirao Preto Medical School, Department of Biochemistry and Immunology, 14049-900 Ribeirao Preto, SP, Brazil
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, W12 ONN, United Kingdom.
| | - Rosemary J Boyton
- Department of Immunology and Inflammation, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, W12 ONN, United Kingdom
| | - Cliomar Alves Dos Santos
- Health Foundation Parreiras Horta, Central Laboratory of Public Health (LACEN/SE), State Secretary for Health, Sergipe, Brazil
| | - Camilla Natália Oliveira Santos
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Juliana Cardoso Alves
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Ianaline Lima Santos
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Lucas Sousa Magalhães
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | | | - Danilo J P G Rocha
- Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - João P P Almeida
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte-MG, Brazil
| | - Luis G C Pacheco
- Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Eric R G R Aguiar
- Department of Biological Sciences, Center of Biotechnology and Genetics, State University of Santa Cruz (UESC), Ilhéus-BA, Brazil
| | - Gubio Soares Campos
- Virology Laboratory, Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Silvia Inês Sardi
- Virology Laboratory, Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Rejane Hughes Carvalho
- Virology Laboratory, Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Amélia Ribeiro de Jesus
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil; Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Karla Freire Rezende
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Roque Pacheco de Almeida
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil; Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil.
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Li Y, Ji D, Cai W, Hu Y, Bai Y, Wu J, Xu J. Clinical characteristics, cause analysis and infectivity of COVID-19 nucleic acid repositive patients: A literature review. J Med Virol 2021; 93:1288-1295. [PMID: 32890414 PMCID: PMC7894340 DOI: 10.1002/jmv.26491] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022]
Abstract
Coronavirus disease 2019 (COVID-19) poses a serious threat to human health and lives. The virus is still spreading throughout the world, and the cumulative number of confirmed cases is increasing. After patients with COVID-19 are treated and discharged, some have repeated clinical symptoms and become positive for nucleic acid tests a second time. Through analysis and review of the existing literature, the proportion of repositive patients in the discharged patient population and their clinical characteristics were systematically described for the first time. Furthermore, an in-depth analysis of the causes of repositive nucleic acid tests and the potential transmission of the disease provides the basis for the management and protection of discharged patients with COVID-19.
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Affiliation(s)
- Youjiang Li
- The Department of Clinical Laboratory, The Fourth Affiliated HospitalZhejiang University School of MedicineYiwuZhejiangChina
| | - Danping Ji
- The Department of Obstetrics and GynecologyShangxi District Medical Community of Yiwu Central HospitalYiwuZhejiangChina
| | - Wangyu Cai
- The Department of Obstetrics and Gynecology, The Fourth Affiliated HospitalZhejiang University School of MedicineYiwuZhejiangChina
| | - Yingying Hu
- The Department of Obstetrics and Gynecology, The Fourth Affiliated HospitalZhejiang University School of MedicineYiwuZhejiangChina
| | - Yongying Bai
- The Department of Clinical Laboratory, Women's HospitalZhejiang University School of MedicineHangzhouChina
| | - Jianguo Wu
- The Department of Clinical Laboratory, The Fourth Affiliated HospitalZhejiang University School of MedicineYiwuZhejiangChina
| | - Jian Xu
- The Department of Obstetrics and Gynecology, The Fourth Affiliated HospitalZhejiang University School of MedicineYiwuZhejiangChina
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Bongiovanni M. COVID-19 reinfection in a healthcare worker. J Med Virol 2021; 93:4058-4059. [PMID: 32990954 PMCID: PMC7537129 DOI: 10.1002/jmv.26565] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Marco Bongiovanni
- Internal Medicine Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
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Pal R, Banerjee M. Are people with uncontrolled diabetes mellitus at high risk of reinfections with COVID-19? Prim Care Diabetes 2021; 15:18-20. [PMID: 32800450 PMCID: PMC7413202 DOI: 10.1016/j.pcd.2020.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
Abstract
Several cases of positive real time-polymerase chain reaction (RT-PCR) results (called "re-positives") after recovery from COVID-19 have emerged worldwide. These cases could represent patients experiencing a "turn positive" of nucleic acid detection attributed to the high false-negative rate of RT-PCR. On the contrary, in symptomatic patients, the possibility of reactivation or true reinfection remains. We hypothesize that people with uncontrolled diabetes mellitus might be at a high risk of reinfections with COVID-19 attributed to the impaired adaptive immune response. In fact, multiple cases of re-positives/re-infections in people with diabetes mellitus have hitherto been reported.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Mainak Banerjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, 700007, India
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Ren X, Wang X, Ge Z, Cui S, Chen Z. Clinical features and corresponding immune function status of recurrent viral polymerase chain reaction positivity in patients with COVID-19 : A meta- analysis and systematic review. Int J Immunopathol Pharmacol 2021; 35:20587384211027679. [PMID: 34162269 PMCID: PMC8236784 DOI: 10.1177/20587384211027679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) was declared a global pandemic in March 2020. Since then, several studies have found COVID-19 patients with recurrent viral polymerase chain reaction (PCR) positivity. METHODS On May 6, 2021, an exhaustive literature search of the Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure databases, Embase, Wan Fang Data, VIP database, Sinomed database, BioRxiv, MedRxiv, and Research Square was conducted to find describing the laboratory indicators of recurrent and non-recurrent viral PCR positivity in patients with COVID-19. The data were statistically analyzed using STATA version 15.0. RESULTS In total, 22 studies-comprising 5154 laboratory-confirmed COVID-19 cases-were included in the analyses. Patients with less severe COVID-19 illness (i.e. those clinically classified as mild or common-type) seemed to exhibit recurrent PCR positivity more commonly than patients with more severe illness (i.e. those classified as severe or critical). There were also significant differences between the two groups in terms of the rates of headaches and dizziness, in addition to the levels of aspartate aminotransferase, C reactive protein, interleukin-6, and lactate dehydrogenase. Further, there were variations in the ratio of CD4+ T cells/CD8+ T cells on admission to the hospital. CONCLUSION In comparison to COVID-19 patients with non-recurrent viral PCR positivity, patients with recurrent virus PCR positivity seem to experience more severe immune function suppression upon hospital admission.
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Affiliation(s)
| | | | - Ziruo Ge
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shuping Cui
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhihai Chen
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Shen L, Cui S, Zhang D, Lin C, Chen L, Wang Q. Comparison of four commercial RT-PCR diagnostic kits for COVID-19 in China. J Clin Lab Anal 2021; 35:e23605. [PMID: 33320386 PMCID: PMC7843276 DOI: 10.1002/jcla.23605] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022] Open
Abstract
We compared the sensitivity and specificity of four commercial coronavirus disease (COVID-19) diagnostic kits using real-time reverse transcription-polymerase chain reaction (RT-PCR). Kits I-IV approved by the State Drug Administration of China were selected, and the detection targets were ORF1ab gene and N gene. Specificity was evaluated by detecting other respiratory viruses. The sensitivity and batch effect of each kit were evaluated by testing 10-fold dilutions of RNA. Clinical application was verified by testing nasopharyngeal swab and sputum specimens from COVID-19 patients. Among the 78 cases infected by other respiratory viruses, no amplification curve was observed using these four COVID-19 RT-PCR kits. The minimum detection limits of kits I-IV were 10-6 , 10-5 , 10-5 , and 10-6 dilutions, respectively, and concentrations were 10 copies/mL (10-5 dilution) and 1 copies/mL (10-6 dilution). The sensitivities of kits I-IV detected using 142 nasopharyngeal swab specimens from COVID-19 patients were 91.55%, 81.69%, 80.28%, and 90.85%, respectively, while they were 92.68%, 85.37%, 82.93%, and 93.90%, respectively, for the 82 sputum samples. The specificity of each kit was 100.00% (77/77). The total expected detection rate using sputum samples was 88.59% (691/780) higher than 86.15% (672/780) of nasopharyngeal swabs. Comparison of nasopharyngeal swab and sputum samples from the same COVID-19 patient led to the detection of ORF1ab and N genes in 16 (100%) sputum samples; only ORF1ab and N genes were detected in 12 (75%) and 14 (87.5%) nasopharyngeal swab specimens, respectively. In conclusion, comparison of commercial COVID-19 RT-PCR kits should be performed before using a new batch of such kits in routine diagnostics.
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Affiliation(s)
- Lingyu Shen
- Institute of Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Municipal Center for Disease Prevention and ControlBeijing Municipal Research Center for Preventive MedicineBeijingP. R. China
| | - Shujuan Cui
- Institute of Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Municipal Center for Disease Prevention and ControlBeijing Municipal Research Center for Preventive MedicineBeijingP. R. China
| | - Daitao Zhang
- Institute of Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Municipal Center for Disease Prevention and ControlBeijing Municipal Research Center for Preventive MedicineBeijingP. R. China
| | - Changying Lin
- Institute of Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Municipal Center for Disease Prevention and ControlBeijing Municipal Research Center for Preventive MedicineBeijingP. R. China
| | - Lijuan Chen
- Institute of Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Municipal Center for Disease Prevention and ControlBeijing Municipal Research Center for Preventive MedicineBeijingP. R. China
| | - Quanyi Wang
- Institute of Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Municipal Center for Disease Prevention and ControlBeijing Municipal Research Center for Preventive MedicineBeijingP. R. China
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Dao TL, Hoang VT, Gautret P. Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: a narrative review. Eur J Clin Microbiol Infect Dis 2021; 40:13-25. [PMID: 33113040 PMCID: PMC7592450 DOI: 10.1007/s10096-020-04088-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Many studies have shown that re-positive tests for SARS-CoV-2 by RT-PCR in recovered COVID-19 patients are very common. We aim to conduct this review to summarize the clinical and epidemiological characteristics of these patients and discuss the potential explanations for recurrences, the contagiousness of re-detectable positive SARS-CoV-2 virus, and the management of COVID-19 patients after discharge from hospital. The proportion of re-positive tests in discharged COVID-19 patients varied from 2.4 to 69.2% and persisted from 1 to 38 days after discharge, depending on population size, age of patients, and type of specimens. Currently, several causes of re-positive tests for SARS-CoV-2 in recovered COVID-19 patients are suggested, including false-negative, false-positive RT-PCR tests; reactivation; and re-infection with SARS-CoV-2, but the mechanism leading to these re-positive cases is still unclear. The prevention of re-positive testing in discharged patients is a fundamental measure to control the spread of the pandemic. In order to reduce the percentage of false-negative tests prior to discharge, we recommend performing more than two tests, according to the standard sampling and microbiological assay protocol. In addition, specimens should be collected from multiple body parts if possible, to identify SARS-CoV-2 viral RNA before discharge. Further studies should be conducted to develop novel assays that target a crucial region of the RNA genome in order to improve its sensitivity and specificity.
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Affiliation(s)
- Thi Loi Dao
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- IHU-Méditerranée Infection, Marseille, France
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Van Thuan Hoang
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- IHU-Méditerranée Infection, Marseille, France
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Gautret
- IRD, AP-HM, SSA, VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
- IHU-Méditerranée Infection, Marseille, France.
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Zhuang Y, Lin L, Xu X, Xia T, Yu H, Fu G, Yang Y, Wang M, Sun H. Dynamic changes on chest CT of COVID-19 patients with solitary pulmonary lesion in initial CT. Jpn J Radiol 2021; 39:32-39. [PMID: 32886292 PMCID: PMC7471640 DOI: 10.1007/s11604-020-01037-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/21/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate the dynamic evolution of image features of COVID-19 patients appearing as a solitary lesion at initial chest CT scan. MATERIALS AND METHODS Twenty-two COVID-19 patients with solitary pulmonary lesion from three hospitals in China were enrolled from January 18, 2020 to March 18, 2020. The clinical feature and laboratory findings at first visit, as well as characteristics and dynamic evolution of chest CT images were analyzed. Among them, the CT score evaluation was the sum of the lung involvement in five lobes (0-5 points for each lobe, with a total score ranging from 0 to 25). RESULTS 22 COVID-19 patients (11 males and 11 females, with an average age of 40.7 ± 10.3) developed a solitary pulmonary lesion within 4 days after the onset of symptoms, the peak time of CT score was about 11 days (with a median CT score of 6), and was discharged about 19 days. The peak of CT score was positively correlated with the peak time and the discharge time (p < 0.001, r = 0.793; p < 0.001, r = 0.715). Scan-1 (first visit): 22 cases (100%) showed GGO and one lobe was involved, CT score was 1.0/1.0 (median/IQR). Scan-2 (peak): 15 cases (68%) showed crazy-paving pattern, 19 cases (86%) showed consolidation, and 2.5 lobes were involved, CT score was 6.0/12.0. Scan-3 (before discharge): ten cases (45%) showed linear opacities, none had crazy-paving pattern, and 2.5 lobes were involved, CT score was 6.0/11.0. Scan-4 (after discharge): three cases (19%) showed linear opacities and one lobe was involved, CT score was 2.0/5.0. CONCLUSION The chest CT features are related to the course of COVID-19 disease, and dynamic chest CT scan are helpful to monitor disease progress and patients' condition. In recovered patients with COVID-19, the positive CT manifestations were found within 4 days, lung involvement peaking at approximately 11 days, and discharged at about 19 days. The patients with more severe the lung injury was, the later the peak time appeared and the longer the recovery time was. Although the lesion was resolved over time, isolation and reexamination were required after discharge.
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Affiliation(s)
- Yuandi Zhuang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Liaoyi Lin
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Xunhua Xu
- Department of Radiology, China Resources and WISCO General Hospital, NO. 209 Yejin Rd, Qingshan District, Wuhan, 430080, Hubei, China
| | - Tianyi Xia
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Huili Yu
- Department of Radiology, China Resources and WISCO General Hospital, NO. 209 Yejin Rd, Qingshan District, Wuhan, 430080, Hubei, China
| | - Gangze Fu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Yunjun Yang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Meihao Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - Houzhang Sun
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang, China.
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Gidari A, Nofri M, Saccarelli L, Bastianelli S, Sabbatini S, Bozza S, Camilloni B, Fusco-Moffa I, Monari C, De Robertis E, Mencacci A, Francisci D. Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature. Eur J Clin Microbiol Infect Dis 2021; 40:1-12. [PMID: 33037944 PMCID: PMC7547550 DOI: 10.1007/s10096-020-04057-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022]
Abstract
Can a patient diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) be infected again? This question is still unsolved. We tried to analyze local and literature cases with a positive respiratory swab after recovery. We collected data from symptomatic patients diagnosed with SARS-CoV-2 infection in the Italian Umbria Region that, after recovery, were again positive for SARS-CoV-2 in respiratory tract specimens. Samples were also assessed for infectivity in vitro. A systematic review of similar cases reported in the literature was performed. The study population was composed of 9 patients during a 4-month study period. Among the new positive samples, six were inoculated in Vero-E6 cells and showed no growth and negative molecular test in culture supernatants. All patients were positive for IgG against SARS-CoV-2 nucleoprotein and/or S protein. Conducting a review of the literature, 1350 similar cases have been found. The presumptive reactivation occurred in 34.5 days on average (standard deviation, SD, 18.7 days) after COVID-19 onset, when the 5.6% of patients presented fever and the 27.6% symptoms. The outcome was favorable in 96.7% of patients, while the 1.1% of them were still hospitalized at the time of data collection and the 2.1% died. Several hypotheses have been formulated to explain new positive respiratory samples after confirmed negativity. According to this study, the phenomenon seems to be due to the prolonged detection of SARS-CoV-2 RNA traces in respiratory samples of recovered patients. The failure of the virus to replicate in vitro suggests its inability to replicate in vivo.
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Affiliation(s)
- Anna Gidari
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy.
| | - Marco Nofri
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Luca Saccarelli
- Department of Anesthesiology, Intensive Care and Pain therapy Center, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Sabrina Bastianelli
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Samuele Sabbatini
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Silvia Bozza
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Barbara Camilloni
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Igino Fusco-Moffa
- Department of Prevention, Local Health Unit Umbria 1, Travel Medicine Unit, Perugia, Italy
| | - Claudia Monari
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Department of Anesthesiology, Intensive Care and Pain therapy Center, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Antonella Mencacci
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
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Liu HQ, Yuan B, An YW, Chen KJ, Hu Q, Hu XP, Zhao J, Dong Y, Chen YX, Li WX, Sun CQ, Wang JC, Wang C, Song S. Clinical characteristics and follow-up analysis of 324 discharged COVID-19 patients in Shenzhen during the recovery period. Int J Med Sci 2021; 18:347-355. [PMID: 33390803 PMCID: PMC7757147 DOI: 10.7150/ijms.50873] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives: Research on recovering COVID-19 patients could be helpful for containing the pandemic and developing vaccines, but we still do not know much about the clinical features, recovery process, and antibody reactions during the recovery period. Methods: We retrospectively analysed the epidemiological information, discharge summaries, and laboratory results of 324 patients. Results: In all, 15 (8.62%) patients experienced chest distress/breath shortness, where 8 of the 15 were severely ill. This means severely ill patients need an extended amount of time to recover after discharge; next, 20 (11.49%) patients experienced anxiety and 21 (12.07%) had headache/insomnia and a small fraction of them complained of anosmia/ageusia, indicating that these patients need treatment for mental and psychological health issues. Regarding the re-positive patients, their CT and laboratory test results showed no obvious evidence of illness progress or infectivity but a high anti-SARS-CoV-2 antibody expression. Conclusion: Recovered COVID-19 patients need psychological and physiological care and treatment, re-positivity can occur in any person, but juveniles, females, and patients with mild/moderate existing symptoms have higher rates of re-positivity, While there is no evidence that turning re-positive has an impact on their infectivity, but it still alerted us that we need differentiate them in the following managements.
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Affiliation(s)
- Han-Qing Liu
- Central Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Bo Yuan
- Department of Neurology, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Ya-Wen An
- Central Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Kai-Jing Chen
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
| | - Qi Hu
- Chinese Academy of Agricultural Sciences Agricultural Genomes Institute at Shenzhen, Genome Analysis Laboratory of the Ministry of Agriculture, Shenzhen 518118, China
| | - Xiao-Peng Hu
- Central Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Jia Zhao
- Central Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Yu Dong
- Department of Neurosurgery, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Yong-Xin Chen
- Department of Neurosurgery, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Wei-Xin Li
- Department of Neurosurgery, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Chang-Qing Sun
- Department of Clinical Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Jian-Chun Wang
- Central Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
| | - Cheng Wang
- Chinese Academy of Agricultural Sciences Agricultural Genomes Institute at Shenzhen, Genome Analysis Laboratory of the Ministry of Agriculture, Shenzhen 518118, China
| | - Shuo Song
- Central Laboratory, Shenzhen Samii Medical Center, Shenzhen 518118, China
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Azam M, Sulistiana R, Ratnawati M, Fibriana AI, Bahrudin U, Widyaningrum D, Aljunid SM. Recurrent SARS-CoV-2 RNA positivity after COVID-19: a systematic review and meta-analysis. Sci Rep 2020; 10:20692. [PMID: 33244060 PMCID: PMC7691365 DOI: 10.1038/s41598-020-77739-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/17/2020] [Indexed: 01/08/2023] Open
Abstract
Present study aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. We searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Fourteen studies of 2568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.8% (95% confidence interval [CI] 11.44–18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.4 days (95% CI 32.65–38.24 days), and from the last negative to the recurrent positive result was 9.8 days (95% CI 7.31–12.22 days). Patients with younger age and a longer initial illness were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes, severe disease, and a low lymphocyte count were less likely to experience. Present study concluded that the incidence of recurrent SARS-CoV-2 positivity was 14.8% suggesting further studies must be conducted to elucidate the possibility of infectious individuals with prolonged or recurrent RNA positivity.
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Affiliation(s)
- Mahalul Azam
- Department of Public Health, Faculty of Sports Science, Universitas Negeri Semarang, Semarang, 50229, Indonesia.
| | - Rina Sulistiana
- Department of Public Health, Faculty of Sports Science, Universitas Negeri Semarang, Semarang, 50229, Indonesia
| | - Martha Ratnawati
- Department of Pulmonology Medicine, SMC Telogorejo Hospital, Semarang, Indonesia
| | - Arulita Ika Fibriana
- Department of Public Health, Faculty of Sports Science, Universitas Negeri Semarang, Semarang, 50229, Indonesia
| | - Udin Bahrudin
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Dian Widyaningrum
- Department of Clinical Pathology, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
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Zhang X, Li M, Zhang B, Chen T, Lv D, Xia P, Sun Z, Shentu X, Chen H, Li L, Qian W. The N gene of SARS-CoV-2 was the main positive component in repositive samples from a cohort of COVID-19 patients in Wuhan, China. Clin Chim Acta 2020; 511:291-297. [PMID: 33096033 PMCID: PMC7575424 DOI: 10.1016/j.cca.2020.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
A significant proportion of repositive in twice-consecutive-negative patients. The N gene was the main target gene that was positive in repositive results. Repositive were only seen in IgM single or both IgM and IgG positive patients.
Background Repositivity of SARS-CoV-2 nucleic acid in discharged COVID-19 patients was reported recently. However, the characteristics of repositive results are still not well understood, leading to a lack of effective monitoring strategies. Methods In the present study, a total of 59 COVID-19 patients were enrolled, and the characteristics of the repositive samples were analyzed. Results The repositive rate in this cohort was 15.79%. The N gene was the main target gene that was positive in the repositive results as well as in the last positive results of all patients. The median duration from diagnosis to the last positive test was 20 days (IQR, 16–31 days), and the longest duration was 40 days. Repositivity was only observed in IgM single- or both IgM- and IgG-positive patients, instead of IgG single-positive patients. Conclusions There was a significant proportion of repositives in the recovered COVID-19 patients, and increasing the required number of negatives for consecutive nucleic acid tests may reduce the incidence of repositives. The recommended monitoring strategy for repositivity is monitoring the N gene in IgM-positive patients. This can ensure high sensitivity while reducing the time and cost of nucleic acid detection.
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Affiliation(s)
- Xuzhao Zhang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
| | - Min Li
- Department of Neurology Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Bin Zhang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Tao Chen
- Department of Neurology Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Dong Lv
- Department of Respiratory Medicine, Shangyu People's Hospital, Shangyu 312300, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Pengfei Xia
- Department of Respiratory Medicine, Lanxi People's Hospital, Lanxi 321100, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Zhuanyi Sun
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Xiaoyan Shentu
- Department of Dermatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Haiyan Chen
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Libin Li
- Department of Surgery Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China; Aid Hubei Medical Team, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
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Mattiuzzi C, Henry BM, Sanchis-Gomar F, Lippi G. SARS-CoV-2 recurrent RNA positivity after recovering from coronavirus disease 2019 (COVID-19): a meta-analysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020014. [PMID: 32921710 PMCID: PMC7717013 DOI: 10.23750/abm.v91i3.10303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Isolation of subjects with active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a pivotal preventive measure in the ongoing coronavirus disease 2019 (COVID-19) pandemic. A growing number of studies reported cases of recurrent SARS-CoV-2 RNA positivity following disease recovery, which were identified with a critical literature search and then meta-analyzed in this article. MATERIALS AND METHODS A digital search was performed in Medline and Web of Science, using the keywords "coronavirus disease 2019" OR "COVID-19" OR "severe acute respiratory disease 2" OR "SARS-CoV-2" AND "recurrence" OR "repositivization" OR "retesting", without date or language restrictions. Recovery was defined as resolution of symptoms, with at least two consecutive negative molecular tests. RESULTS A total number of 17 studies, with 5,182 COVID-19 patients, were included. SARS-CoV-2 recurrent RNA positivity in recovered COVID-19 patients ranged between 7-23% across the studies, with follow-up testing between 1-60 days. The estimated cumulative rate of SARS-CoV-2 recurrent RNA positivity was 12% (95% confidence interval, 12-13%; I2, 74%). CONCLUSIONS Repeated molecular testing on respiratory tracts specimens at 1 and 2 months after recovery from COVID-19 is strongly advisable for early identification, isolation and clinical management of subjects with SARS-CoV-2 recurrent RNA positivity.
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Affiliation(s)
- Camilla Mattiuzzi
- Service of Clinical Governance, Provincial Agency for Social and Sanitary Services, Trento, Italy.
| | - Brandon M Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy.
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Jin YH, Zhan QY, Peng ZY, Ren XQ, Yin XT, Cai L, Yuan YF, Yue JR, Zhang XC, Yang QW, Ji J, Xia J, Li YR, Zhou FX, Gao YD, Yu Z, Xu F, Tu ML, Tan LM, Yang M, Chen F, Zhang XJ, Zeng M, Zhu Y, Liu XC, Yang J, Zhao DC, Ding YF, Hou N, Wang FB, Chen H, Zhang YG, Li W, Chen W, Shi YX, Yang XZ, Wang XJ, Zhong YJ, Zhao MJ, Li BH, Ma LL, Zi H, Wang N, Wang YY, Yu SF, Li LY, Huang Q, Weng H, Ren XY, Luo LS, Fan MR, Huang D, Xue HY, Yu LX, Gao JP, Deng T, Zeng XT, Li HJ, Cheng ZS, Yao X, Wang XH. Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version). Mil Med Res 2020; 7:41. [PMID: 32887670 PMCID: PMC7472403 DOI: 10.1186/s40779-020-00270-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 02/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
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Affiliation(s)
- Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Qing-Yuan Zhan
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 10029, China
| | - Zhi-Yong Peng
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xue-Qun Ren
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Xun-Tao Yin
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Lin Cai
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Departments of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yu-Feng Yuan
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ji-Rong Yue
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiao-Chun Zhang
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Qi-Wen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, 100730, China
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University and Region Skåne, 25002, Malmö, Sweden
| | - Jian Xia
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 403371, China
| | - Yi-Rong Li
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fu-Xiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, 43071, China
| | - Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhui Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Feng Xu
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, 250002, China
| | - Ming-Li Tu
- Department of Respiratory and Critical Care Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, 441300, Hubei, China
| | - Li-Ming Tan
- Department of Clinic Pharmacy, Second People's Hospital of Huaihua City, Huaihua, 418000, Hunan, China
| | - Min Yang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Fang Chen
- Department of Internal Medicine, Zhengzhou University Hospital, Zhengzhou, 450001, China
| | - Xiao-Ju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yu Zhu
- Department of Infectious Disease, West China Second Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin-Can Liu
- Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Jian Yang
- Department of Cardiology, Yichang NO.1 Hospital, Renmin Hospital of China Three Gorges University, Yichang, 443000, Hubei, China
| | - Dong-Chi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yu-Feng Ding
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ning Hou
- Department of Pharmacy, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, China
| | - Fu-Bing Wang
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Chen
- Laboratory of Integrated Acupuncture and Drugs, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yong-Gang Zhang
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Periodical Press, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Li
- Department of Clinical Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, China
| | - Wen Chen
- Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Yue-Xian Shi
- School of Nursing, Peking University, Beijing, 100191, China
| | - Xiu-Zhi Yang
- Department of Respiratory and Critical Care Medicine, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China
| | - Xue-Jun Wang
- Department of Emergency, Beijing Electric Power Hospital, Beijing, 100073, China
| | - Yan-Jun Zhong
- ICU Center, The Second Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Na Wang
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
- College of Nursing and Health, Henan Medical School, Henan University, Kaifeng, 475000, Henan, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shao-Fu Yu
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Clinic Pharmacy, Second People's Hospital of Huaihua City, Huaihua, 418000, Hunan, China
| | - Lu-Yao Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiang-Ying Ren
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
- College of Nursing and Health, Henan Medical School, Henan University, Kaifeng, 475000, Henan, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Man-Ru Fan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong-Yang Xue
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Xin Yu
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jin-Ping Gao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- School of Nursing, Shanxi Medical University, Taiyuan, 030001, China
| | - Tong Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China.
| | - Hong-Jun Li
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China.
| | - Zhen-Shun Cheng
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China.
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Xiaomei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada.
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China.
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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45
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Du HW, Chen JN, Pan XB, Chen XL, Fang SF, Li XQ, Xia PC, Gao L, Lin HL, Chen LM, Liu N. Prevalence and outcomes of re-positive nucleic acid tests in discharged COVID-19 patients. Eur J Clin Microbiol Infect Dis 2020; 40:413-417. [PMID: 32865669 PMCID: PMC7456660 DOI: 10.1007/s10096-020-04024-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
The prevalence and outcomes of patients who had re-activation of coronavirus disease 2019 (COVID-19) after discharge remain poorly understood. We included 126 consecutively confirmed cases of COVID-19 with 2-month follow-up data after discharge in this retrospective study. The upper respiratory specimen using a reverse-transcription polymerase chain reaction test of three patients (71 years [60–76]) were positive within 11–20 days after their discharge, with an event rate of 19.8 (95%CI 2.60–42.1) per 1,000,000 patient-days. Moreover, all re-positive patients were asymptomatic. Our findings suggest that few recovered patients may still be virus carriers even after reaching the discharge criteria.
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Affiliation(s)
- Hou-Wei Du
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun-Nian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiao-Bin Pan
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Xiao-Ling Chen
- Department of Infectious Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shuang-Fang Fang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiao-Qing Li
- Fujian Center for Disease Control and Prevention, Fuzhou, China
| | - Pin-Cang Xia
- Fujian Center for Disease Control and Prevention, Fuzhou, China
| | - Lei Gao
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hai-Long Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Li-Min Chen
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Nan Liu
- Department of Neurology, Department of Rehabilitation, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 35000, China.
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46
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Lu J, Yin Q, Li Q, Fu G, Hu X, Huang J, Chen L, Li Q, Guo Z. Clinical characteristics and factors affecting the duration of positive nucleic acid test for patients of COVID-19 in XinYu, China. J Clin Lab Anal 2020; 34:e23534. [PMID: 32860649 PMCID: PMC7595898 DOI: 10.1002/jcla.23534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background The outbreak of a new coronavirus, COVID‐19, which was earliest reported in Wuhan, China, is now transmitting throughout the world. The aim of this study was to articulate the clinical characteristics of COVID‐19 and to reveal possible factors that may affect the persistent time of positive SARS‐CoV‐2 nucleic acid test, so as to identify which patients may deteriorate or have poor prognoses as early as possible. Methods Retrospective cohort study was carried out on 47 patients with confirmed COVID‐19 infection admitted to XinYu People's Hospital of JiangXi Province. Epidemiological, demographic, clinical, laboratorial, management, treatment, and outcome data were also collected and analyzed. Results In this study, patients were divided into two groups based on whether their SARS‐CoV‐2 nucleic acid tests in respiratory specimens turn negative within (Group Rapid or Group R) or over (Group Slow or Group S) a week. There was no significant difference in age, sex, travel or exposure history, and smoking history between the two groups. Forty‐two patients had been observed with comorbidities. Similar clinical manifestations, for instance fever, cough, sputum, and fatigue, have been observed among patients in both groups, except that patients in Group S were obviously more likely to get fatigue than patients in Group R. Both groups had shown decrease in white blood cell or lymphocyte counts. Chest X‐ray or computed tomography scan showed unilateral or bilateral infiltrates. High proportion in both groups has used nasal cannula (89.47% vs. 85.71%) to inhale oxygen. 10.53% of Group S have applied high‐flow nasal cannula, while Group R used none. The current treatment is mainly antibiotics, antiviral, and traditional Chinese medicine, while a couple of patients has used methylprednisolone. Only 1 patient out of both groups got even worse despite this active treatment. Conclusion Clinical characteristics of COVID‐19 include the exposure history and typical systemic symptoms such as fever, cough, fatigue, decreased WBC and lymphocyte counts, and infiltration in both lower lobes on CT imaging. Among them, fatigue appears to be an important factor that affects the duration of positive SARS‐CoV‐2 nucleic acid test in respiratory specimens.
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Affiliation(s)
- Jingjing Lu
- Department of Pulmonary and Critical Care Medicine, Shanghai, East Hospital, Tongji University School of Medicine, Pudong, Shanghai, China
| | - Qi Yin
- Department of Pulmonary and Critical Care Medicine, Shanghai, East Hospital, Tongji University School of Medicine, Pudong, Shanghai, China
| | - Quan Li
- Department of Respiratory Medicine, Shanghai East Hospital JiAn Hospital, JiAn, JiangXi, China
| | - Gang Fu
- Department of Infectious Diseases, XinYu People's Hospital, XinYu, JiangXi, China
| | - Xueping Hu
- Department of Pulmonary and Critical Care Medicine, Shanghai, East Hospital, Tongji University School of Medicine, Pudong, Shanghai, China
| | - Jianhao Huang
- Department of Pulmonary and Critical Care Medicine, Shanghai, East Hospital, Tongji University School of Medicine, Pudong, Shanghai, China
| | - Lin Chen
- Department of Respiratory Medicine, Shanghai East Hospital JiAn Hospital, JiAn, JiangXi, China
| | - Qiang Li
- Department of Pulmonary and Critical Care Medicine, Shanghai, East Hospital, Tongji University School of Medicine, Pudong, Shanghai, China
| | - Zhongliang Guo
- Department of Pulmonary and Critical Care Medicine, Shanghai, East Hospital, Tongji University School of Medicine, Pudong, Shanghai, China
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47
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Bongiovanni M, Vignati M, Giuliani G, Manes G, Arienti S, Pelucchi L, Cattaneo N, Bodini BD, Clerici D, Rosa F, Pellegrini L, Schettino M, Picascia D, Bini F. The dilemma of COVID-19 recurrence after clinical recovery. J Infect 2020; 81:979-997. [PMID: 32810521 PMCID: PMC7428731 DOI: 10.1016/j.jinf.2020.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Marco Bongiovanni
- Internal Medicine Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy.
| | - Marco Vignati
- RSA Sandro Pertini, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | | | - Giampiero Manes
- Gastroenterology Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Stefania Arienti
- RSA Sandro Pertini, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Loris Pelucchi
- RSA Sandro Pertini, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | | | - Bruno Dino Bodini
- Pneumology Unit, Department of Medicine, Ospedale Salvini Garbagnate Milanese, ASST Rhodense, Milan, Italy
| | - Danila Clerici
- RSA Sandro Pertini, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Fabio Rosa
- RSA Sandro Pertini, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Lucienne Pellegrini
- Gastroenterology Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Mario Schettino
- Gastroenterology Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Desiree Picascia
- Gastroenterology Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Francesco Bini
- Pneumology Unit, Department of Medicine, Ospedale Salvini Garbagnate Milanese, ASST Rhodense, Milan, Italy
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48
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Zhu H, Fu L, Jin Y, Shao J, Zhang S, Zheng N, Fan L, Yu Z, Ying J, Hu Y, Chen T, Chen Y, Chen M, Chen M, Xiong Z, Kang J, Jin J, Cai T, Ye H. Clinical features of COVID-19 convalescent patients with re-positive nucleic acid detection. J Clin Lab Anal 2020; 34:e23392. [PMID: 32506726 PMCID: PMC7300578 DOI: 10.1002/jcla.23392] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/19/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID‐19) is a pandemic that has rapidly spread worldwide. Increasingly, confirmed patients being discharged according to the current diagnosis and treatment protocols, follow‐up of convalescent patients is important to knowing about the outcome. Methods A retrospective study was performed among 98 convalescent patients with COVID‐19 in a single medical center. The clinical features of patients during their hospitalization and 2‐week postdischarge quarantine were collected. Results Among the 98 COVID‐19 convalescent patients, 17 (17.3%) were detected positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) nucleic acid during 2‐week postdischarge quarantine. The median time from discharge to SARS‐CoV‐2 nucleic acid re‐positive was 4 days (IQR, 3‐8.5).The median time from symptoms onset to final respiratory SARS‐CoV‐2 detection of negative result was significantly longer in re‐positive group (34 days [IQR, 29.5‐42.5]) than in non‐re‐positive group (19 days [IQR, 16‐26]). On the other hand, the levels of CD3‐CD56 + NK cells during hospitalization and 2‐week postdischarge were higher in re‐positive group than in non‐re‐positive group (repeated measures ANOVA, P = .018). However, only one case in re‐positive group showed exudative lesion recurrence in pulmonary computed tomography (CT) with recurred symptoms. Conclusion It is still possible for convalescent patients to show positive for SARS‐CoV‐2 nucleic acid detection, but most of the re‐positive patients showed no deterioration in pulmonary CT findings. Continuous quarantine and close follow‐up for convalescent patients are necessary to prevent possible relapse and spread of the disease to some extent.
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Affiliation(s)
- Hui Zhu
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Liyun Fu
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China.,Department of Hepatology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yinhua Jin
- Department of Radiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiale Shao
- Department of Respiratory, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Shun Zhang
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Nanhong Zheng
- Department of Acute Infection, HwaMei Hospital University of Chinese Academy of Sciences, Ningbo, China
| | - Lingyan Fan
- Department of Acute Infection, HwaMei Hospital University of Chinese Academy of Sciences, Ningbo, China
| | - Zhe Yu
- Department of Respiratory, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jun Ying
- Department of Respiratory, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yaoren Hu
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China.,Department of Hepatology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Tongen Chen
- Department of General practice, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yanglingzi Chen
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Min Chen
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Mingjue Chen
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Zi Xiong
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Junfei Kang
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Jiachang Jin
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Ting Cai
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Honghua Ye
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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