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Concas G, Barone M, Francavilla R, Cristofori F, Dargenio VN, Giorgio R, Dargenio C, Fanos V, Marcialis MA. Twelve Months with COVID-19: What Gastroenterologists Need to Know. Dig Dis Sci 2022; 67:2771-2791. [PMID: 34333726 PMCID: PMC8325547 DOI: 10.1007/s10620-021-07158-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Corona virus disease-19 (COVID-19) is the latest global pandemic. COVID-19 is mainly transmitted through respiratory droplets and, apart from respiratory symptoms, patients often present with gastrointestinal symptoms and liver involvement. Given the high percentage of COVID-19 patients that present with gastrointestinal symptoms (GIS), in this review, we report a practical up-to-date reference for the physician in their clinical practice with patients affected by chronic gastrointestinal (GI) diseases (inflammatory bowel disease, coeliac disease, chronic liver disease) at the time of COVID-19. First, we summarised data on the origin and pathogenetic mechanism of SARS-CoV-2. Then, we performed a literature search up to December 2020 examining clinical manifestations of GI involvement. Next, we illustrated and summarised the most recent guidelines on how to adhere to GI procedures (endoscopy, liver biopsy, faecal transplantation), maintaining social distance and how to deal with immunosuppressive treatment. Finally, we focussed on some special conditions such as faecal-oral transmission and gut microbiota. The rapid accumulation of information relating to this condition makes it particularly essential to revise the literature to take account of the most recent publications for medical consultation and patient care.
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Affiliation(s)
- Giulia Concas
- School of Paediatrics, University of Cagliari, 09124 Cagliari, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, University Hospital “Policlinico”, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Ruggiero Francavilla
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Fernanda Cristofori
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vanessa Nadia Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Rossella Giorgio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Costantino Dargenio
- Department of Biomedical Science and Human Oncology, Children’s Hospital “Giovanni XXIII”, University of Bari, 70126 Bari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, University of Cagliari, Cagliari, 09124 Cagliari, Italy
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2
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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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3
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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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4
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Stanoeva KR, van der Eijk AA, Meijer A, Kortbeek LM, Koopmans MPG, Reusken CBEM. Towards a sensitive and accurate interpretation of molecular testing for SARS-CoV-2: a rapid review of 264 studies. Euro Surveill 2021; 26:2001134. [PMID: 33706863 PMCID: PMC7953531 DOI: 10.2807/1560-7917.es.2021.26.10.2001134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
BackgroundSensitive molecular diagnostics and correct test interpretation are crucial for accurate COVID-19 diagnosis and thereby essential for good clinical practice. Furthermore, they are a key factor in outbreak control where active case finding in combination with isolation and contact tracing are crucial.AimWith the objective to inform the public health and laboratory responses to the pandemic, we reviewed current published knowledge on the kinetics of SARS-CoV-2 infection as assessed by RNA molecular detection in a wide range of clinical samples.MethodsWe performed an extensive search on studies published between 1 December 2019 and 15 May 2020, reporting on molecular detection and/or isolation of SARS-CoV-2 in any human laboratory specimen.ResultsWe compiled a dataset of 264 studies including 32,515 COVID-19 cases, and additionally aggregated data points (n = 2,777) from sampling of 217 adults with known infection timeline. We summarised data on SARS-CoV-2 detection in the respiratory and gastrointestinal tract, blood, oral fluid, tears, cerebrospinal fluid, peritoneal fluid, semen, vaginal fluid; where provided, we also summarised specific observations on SARS-CoV-2 detection in pregnancy, infancy, children, adolescents and immunocompromised individuals.ConclusionOptimal SARS-CoV-2 molecular testing relies on choosing the most appropriate sample type, collected with adequate sampling technique, and with the infection timeline in mind. We outlined knowledge gaps and directions for future well-documented systematic studies.
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Affiliation(s)
- Kamelia R Stanoeva
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Adam Meijer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Laetitia M Kortbeek
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Marion P G Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chantal B E M Reusken
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
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5
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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] [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 Therapy, Horus University - Egypt, New Damietta, Egypt
| | - Adam Kline
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Abdelaziz Elgaml
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt.,Department of Microbiology and Immunology, Faculty of Pharmacy, Horus University - Egypt, New Damietta, Egypt
| | - Mohamed H Aboutaleb
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University - Egypt, New Damietta, Egypt
| | - Mohamed M Salim
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University - Egypt, New Damietta, Egypt.,Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ruhul Munshi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Mohammad H Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Abdallah S Attia
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Eman A Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Genetics Unit, Histology and Cell Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmad Settin
- Pediatrics and Genetics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mary Killackey
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Department of Biochemistry, College of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
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6
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Tantuoyir MM, Rezaei N. Serological tests for COVID-19: Potential opportunities. Cell Biol Int 2021; 45:740-748. [PMID: 33289157 PMCID: PMC7753382 DOI: 10.1002/cbin.11516] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a novel betacoronavirus, caused a pandemic leading to a standstill of nearly all global activities. There are some controversies on the production of specific immunoglobulin M (IgM) and IgG antibodies after the infection with SARS‐CoV‐2. This paper seeks to elaborate on the potential application of IgM and IgG antibodies and the viral antigens for the diagnosis and the course of the disease as well as the recurrence of positive nucleic acid tests after discharge.
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Affiliation(s)
- Marcarious M Tantuoyir
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Biomedical Engineering Unit, University of Ghana Medical Center (UGMC), Accra, Ghana.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Accra, Ghana
| | - Nima Rezaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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7
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Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27:520-531. [PMID: 33418017 PMCID: PMC7785281 DOI: 10.1016/j.cmi.2020.12.018] [Citation(s) in RCA: 433] [Impact Index Per Article: 144.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
Background The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. Objective The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. Data Sources We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. Study Eligibility Criteria We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. Participants The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). Methods The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. Results We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Conclusions Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
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8
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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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9
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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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10
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O Murchu E, Byrne P, Walsh KA, Carty PG, Connolly M, De Gascun C, Jordan K, Keoghan M, O'Brien KK, O'Neill M, Smith SM, Teljeur C, Ryan M, Harrington P. Immune response following infection with SARS-CoV-2 and other coronaviruses: A rapid review. Rev Med Virol 2020; 31:e2162. [PMID: 32964627 PMCID: PMC7536965 DOI: 10.1002/rmv.2162] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022]
Abstract
In this review, we systematically searched and summarized the evidence on the immune response and reinfection rate following SARS‐CoV‐2 infection. We also retrieved studies on SARS‐CoV and MERS‐CoV to assess the long‐term duration of antibody responses. A protocol based on Cochrane rapid review methodology was adhered to and databases were searched from 1/1/2000 until 26/5/2020. Of 4744 citations retrieved, 102 studies met our inclusion criteria. Seventy‐four studies were retrieved on SARS‐CoV‐2. While the rate and timing of IgM and IgG seroconversion were inconsistent across studies, most seroconverted for IgG within 2 weeks and 100% (N = 62) within 4 weeks. IgG was still detected at the end of follow‐up (49‐65 days) in all patients (N = 24). Neutralizing antibodies were detected in 92%‐100% of patients (up to 53 days). It is not clear if reinfection with SARS‐CoV‐2 is possible, with studies more suggestive of intermittent detection of residual RNA. Twenty‐five studies were retrieved on SARS‐CoV. In general, SARS‐CoV‐specific IgG was maintained for 1‐2 years post‐infection and declined thereafter, although one study detected IgG up to 12 years post‐infection. Neutralizing antibodies were detected up to 17 years in another study. Three studies on MERS‐CoV reported that IgG may be detected up to 2 years. In conclusion, limited early data suggest that most patients seroconvert for SARS‐CoV‐2‐specific IgG within 2 weeks. While the long‐term duration of antibody responses is unknown, evidence from SARS‐CoV studies suggest SARS‐CoV‐specific IgG is sustained for 1‐2 years and declines thereafter.
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Affiliation(s)
- Eamon O Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland.,The Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland
| | - Paula Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Kieran A Walsh
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Paul G Carty
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Máire Connolly
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Cillian De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - Karen Jordan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Mary Keoghan
- Department of Clinical Immunology, Beaumont Hospital, Dublin 9, Ireland
| | - Kirsty K O'Brien
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Michelle O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Susan M Smith
- Department of General Practice, Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Conor Teljeur
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Máirín Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland.,Department of Pharmacology & Therapeutics, Trinity Health Sciences, Trinity College Dublin, Dublin 8, Ireland
| | - Patricia Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin 7, Ireland
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11
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Chen LZ, Lin ZH, Chen J, Liu SS, Shi T, Xin YN. Can elevated concentrations of ALT and AST predict the risk of 'recurrence' of COVID-19? Epidemiol Infect 2020; 148:e218. [PMID: 32951624 PMCID: PMC7522471 DOI: 10.1017/s0950268820002186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/08/2020] [Accepted: 08/28/2020] [Indexed: 12/15/2022] Open
Abstract
'Recurrence' of coronavirus disease 2019 (COVID-19) has triggered numerous discussions of scholars at home and abroad. A total of 44 recurrent cases of COVID-19 and 32 control cases admitted from 11 February to 29 March 2020 to Guanggu Campus of Tongji Hospital affiliated to Tongji Medical College Huazhong University of Science and Technology were enrolled in this study. All the 44 recurrent cases were classified as mild to moderate when the patients were admitted for the second time. The gender and mean age in both cases (recurrent and control) were similar. At least one concomitant disease was observed in 52.27% recurrent cases and 34.38% control cases. The most prevalent comorbidity among them was hypertension. Fever and cough being the most prevalent clinical symptoms in both cases. On comparing both the cases, recurrent cases had markedly elevated concentrations of alanine aminotransferase (ALT) (P = 0.020) and aspartate aminotransferase (AST) (P = 0.007). Moreover, subgroup analysis showed mild to moderate abnormal concentrations of ALT and AST in recurrent cases. The elevated concentrations of ALT and AST may be recognised as predictive markers for the risk of 'recurrence' of COVID-19, which may provide insights into the prevention and control of COVID-19 in the future.
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Affiliation(s)
- L. Z. Chen
- Department of Infectious Disease, Qingdao Municipal Hospital Group, Qingdao, China
| | - Z. H. Lin
- Department of Gastroenterology, Qingdao Municipal Hospital Group, Qingdao, China
| | - J. Chen
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - S. S. Liu
- Hepatology Laboratory, Qingdao Municipal Hospital Group, Qingdao, China
- Digestive Disease Key Laboratory of Qingdao, Qingdao, China
| | - T. Shi
- Department of Gastroenterology, Qingdao Municipal Hospital Group, Dalian Medical University, Qingdao, China
| | - Y. N. Xin
- Department of Infectious Disease, Qingdao Municipal Hospital Group, Qingdao, China
- Department of Gastroenterology, Qingdao Municipal Hospital Group, Qingdao, China
- Hepatology Laboratory, Qingdao Municipal Hospital Group, Qingdao, China
- Digestive Disease Key Laboratory of Qingdao, Qingdao, China
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12
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Moon SS, Lee K, Park J, Yun S, Lee YS, Lee DS. Clinical Characteristics and Mortality Predictors of COVID-19 Patients Hospitalized at Nationally-Designated Treatment Hospitals. J Korean Med Sci 2020; 35:e328. [PMID: 32924343 PMCID: PMC7490203 DOI: 10.3346/jkms.2020.35.e328] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) was first reported in December 2019 in China, and then it has disseminated worldwide. In Korea, a religious group-related super-spreading event triggered a sudden outbreak in Daegu city and Gyeongsangbuk-do in southeast Korea. This study was undertaken to document the clinical characteristics of patients hospitalized in Gyeongsangbuk-do. METHODS Three hundred and fifty-two patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalized at Dongguk University Gyeongju Hospital or at the Andong Medical Center between February 18th and June 30th were enrolled in this study. Medical records were reviewed and demographic and clinical features, including comorbidities, symptoms, radiological and laboratory findings on admission were analyzed. In addition, we sought to identify risk factors of mortality. RESULTS Mean age of the 352 study subjects was 56 years (range, 14-95). The mortality rate was 6.8% and mean age at death was 81 years (range, 57-91). The most common symptom was cough (31.8%) followed by a febrile sensation (28.4%), sputum (17.0%), sore throat (15.6%), and myalgia (13.1%). Eighty-one (23.0%) patients were asymptomatic, but a half of these patients exhibited pneumonic infiltration at presentation. Chest radiology showed no active lesion in 41.8% of the study subjects, bilateral pneumonia in 46.9%, and unilateral pneumonic infiltration in 11.4%. Among 24 patients that died, 18 subjects were transferred from a care facility. An age of ≥ 70 years, previous history of malignancy or diabetes, and fever (≥ 37.5°C) on admission were found to be significant risk factors of mortality. CONCLUSION Patients aged ≥ 70 years, those with fever on admission, and patients with an underlying malignancy or diabetes were found to be more likely to succumb to COVID-19. Elderly in care facilities or hospitalized patients with an underlying disease should receive more attention and be considered for preventive quarantine.
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Affiliation(s)
- Seong Su Moon
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
| | - Kwan Lee
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jungi Park
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Seongcheol Yun
- Department of Internal Medicine, Andong Medical Center, Andong, Korea
| | - Yun Sik Lee
- Department of General Surgery, Andong Medical Center, Andong, Korea
| | - Dong Seok Lee
- Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea
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13
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Abdullah MS, Chong PL, Asli R, Momin RN, Mani BI, Metussin D, Chong VH. Post discharge positive re-tests in COVID-19: common but clinically non-significant. Infect Dis (Lond) 2020; 52:743-745. [PMID: 32579420 DOI: 10.1080/23744235.2020.1780309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Muhammad Syafiq Abdullah
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.,Institute of Health Sciences, PAPRSB, Universiti Brunei Darussalam, Gadong, Brunei
| | - Pui Lin Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Rosmonaliza Asli
- Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Riamiza Natalie Momin
- Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Babu Ivan Mani
- Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam
| | - Dhiya Metussin
- Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Vui Heng Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.,Institute of Health Sciences, PAPRSB, Universiti Brunei Darussalam, Gadong, Brunei.,Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam
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