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Sharma S, Caputi M, Asghar W. Development of a Diagnostic Microfluidic Chip for SARS-CoV-2 Detection in Saliva and Nasopharyngeal Samples. Viruses 2024; 16:1190. [PMID: 39205164 PMCID: PMC11360425 DOI: 10.3390/v16081190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
The novel coronavirus SARS-CoV-2 was first isolated in late 2019; it has spread to all continents, infected over 700 million people, and caused over 7 million deaths worldwide to date. The high transmissibility of the virus and the emergence of novel strains with altered pathogenicity and potential resistance to therapeutics and vaccines are major challenges in the study and treatment of the virus. Ongoing screening efforts aim to identify new cases to monitor the spread of the virus and help determine the danger connected to the emergence of new variants. Given its sensitivity and specificity, nucleic acid amplification tests (NAATs) such as RT-qPCR are the gold standard for SARS-CoV-2 detection. However, due to high costs, complexity, and unavailability in low-resource and point-of-care (POC) settings, the available RT-qPCR assays cannot match global testing demands. An alternative NAAT, RT-LAMP-based SARS-CoV-2 detection offers scalable, low-cost, and rapid testing capabilities. We have developed an automated RT-LAMP-based microfluidic chip that combines the RNA isolation, purification, and amplification steps on the same device and enables the visual detection of SARS-CoV-2 within 40 min from saliva and nasopharyngeal samples. The entire assay is executed inside a uniquely designed, inexpensive disposable microfluidic chip, where assay components and reagents have been optimized to provide precise and qualitative results and can be effectively deployed in POC settings. Furthermore, this technology could be easily adapted for other novel emerging viruses.
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Affiliation(s)
- Sandhya Sharma
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA
| | - Massimo Caputi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Waseem Asghar
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA
- Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL 33431, USA
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2
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Zhou XJ, Horga A, Puri A, Winchester L, Montrond M, Pietropaolo K, Belanger B, Fletcher CV, Hammond J. Human bronchopulmonary disposition and plasma pharmacokinetics of oral bemnifosbuvir (AT-527), an experimental guanosine nucleotide prodrug for COVID-19. J Antimicrob Chemother 2024; 79:1423-1431. [PMID: 38708557 PMCID: PMC11144486 DOI: 10.1093/jac/dkae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Bemnifosbuvir (AT-527) is a novel oral guanosine nucleotide antiviral drug for the treatment of persons with COVID-19. Direct assessment of drug disposition in the lungs, via bronchoalveolar lavage, is necessary to ensure antiviral drug levels at the primary site of SARS-CoV-2 infection are achieved. OBJECTIVES This Phase 1 study in healthy subjects aimed to assess the bronchopulmonary pharmacokinetics, safety and tolerability of repeated doses of bemnifosbuvir. METHODS A total of 24 subjects were assigned to receive bemnifosbuvir twice daily at doses of 275, 550 or 825 mg for up to 3.5 days. RESULTS AT-511, the free base of bemnifosbuvir, was largely eliminated from the plasma within 6 h post dose in all dosing groups. Antiviral drug levels of bemnifosbuvir were consistently achieved in the lungs with bemnifosbuvir 550 mg twice daily. The mean level of the guanosine nucleoside metabolite AT-273, the surrogate of the active triphosphate metabolite of the drug, measured in the epithelial lining fluid of the lungs was 0.62 µM at 4-5 h post dose. This exceeded the target in vitro 90% effective concentration (EC90) of 0.5 µM for antiviral drug exposure against SARS-CoV-2 replication in human airway epithelial cells. Bemnifosbuvir was well tolerated across all doses tested, and most treatment-emergent adverse events reported were mild in severity and resolved. CONCLUSIONS The favourable pharmacokinetics and safety profile of bemnifosbuvir demonstrates its potential as an oral antiviral treatment for COVID-19, with 550 mg bemnifosbuvir twice daily currently under further clinical evaluation in persons with COVID-19.
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Affiliation(s)
| | | | - Adeep Puri
- Hammersmith Medicines Research Ltd, London, UK
| | - Lee Winchester
- Antiviral Pharmacology Laboratory, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | | | - Courtney V Fletcher
- Antiviral Pharmacology Laboratory, University of Nebraska Medical Center, Omaha, NE, USA
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3
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Silva ETT, Furtado FB, da Silveira RA, Tasca KI, Silva CN, Godoy AT, de Moraes LN, Hong MV, Alves CG, Simões RP, Kubo AMS, Fortaleza CMCB, Pereira-Lima MC, Valente GT, Grotto RMT. Saliva as a Biological Fluid in SARS-CoV-2 Detection. Diagnostics (Basel) 2024; 14:922. [PMID: 38732336 PMCID: PMC11083664 DOI: 10.3390/diagnostics14090922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The polymerase chain reaction of upper respiratory tract swab samples was established as the gold standard procedure for diagnosing SARS-CoV-2 during the COVID pandemic. However, saliva collection has attracted attention as an alternative diagnostic collection method. The goal of this study was to compare the use of saliva and nasopharyngeal swab (NPS) samples for the detection of SARS-CoV-2. METHODS Ninety-nine paired samples were evaluated for the detection of SARS-CoV-2 by saliva and swab for a qualitative diagnosis and quantitative comparison of viral particles. Furthermore, the detection limits for each sample collection technique were determined. The cycle threshold (CT) values of the saliva samples, the vaccination status, and the financial costs associated with each collection technique were compared. RESULTS The results showed qualitative equivalence in diagnosis (96.96%) comparing saliva and swab collection, although there was low quantitative agreement. Furthermore, the detection limit test demonstrated equivalence for both collection methods. We did not observe a statistically significant association between CT values and vaccination status, indicating that the vaccine had no influence on viral load at diagnosis. Finally, we observed that the use of saliva incurs lower financial costs and requires less use of plastic materials, making it more sustainable. CONCLUSIONS These findings support the adoption of saliva collection as a feasible and sustainable alternative to the diagnosis of COVID-19.
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Affiliation(s)
- Emily Thalia Teixeira Silva
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Fabiana Barcelos Furtado
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Rosana Antunes da Silveira
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Karen Ingrid Tasca
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Cristiane Nonato Silva
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Amanda Thais Godoy
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Leonardo Nazario de Moraes
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
- Department of Bioprocess and Biotechnology, School of Agriculture, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
| | - Michelle Venancio Hong
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Camila Gonçalves Alves
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Rafael Plana Simões
- Department of Bioprocess and Biotechnology, School of Agriculture, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
| | - Agatha Mayume Silva Kubo
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Maria Cristina Pereira-Lima
- Department of Neurology, Psychology and Psychiatry, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
| | - Guilherme Targino Valente
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Rejane Maria Tommasini Grotto
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
- Department of Bioprocess and Biotechnology, School of Agriculture, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
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Xiao X, Chen P, Zhong Y, Luo X, Liu Y, Lu Y, Jin X, Qian W, Han W, Liang A, Liu H. Outcomes and risk factors of SARS-CoV-2 omicron variant in B-cell lymphoma patients following CD19 targeted CAR-T therapy. Cancer Med 2023; 12:20838-20846. [PMID: 37962082 PMCID: PMC10709723 DOI: 10.1002/cam4.6657] [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: 06/14/2023] [Revised: 08/23/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Little was known on infection and mortality rates, still less the risk factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in B-cell lymphoma patients following CD19 targeted chimeric antigen receptor T cell (CAR-T). AIMS We performed a retrospective multicenter study and analyzed the details of relapsed/refractory (R/R) B-cell lymphoma patients who received CD19 targeted CAR-T heretofore in five cellular immunotherapy centers in China during the omicron wave. MATERIALS & METHODS One hundred fifty-four patients were enrolled in this study. RESULTS Among them, 52 patients (33.8%) were uninfected, 74 patients (48.1) had ambulatory mild disease (including nine patients of asymptomatic infection), 22 patients (14.3%) had moderate disease and six patients (3.9%) had severe disease when data collected up. Three patients with severe disease died from COVID-19, the death rate was 1.9% for all enrolled patients, and 2.9% for infected patients. We also found that patients over 60 years old or with diabetes mellitus (DM) tend to develop severe disease (p = 0.0057 and p = 0.0497, respectively). Patients had CAR-T infusion within 6 months also tend to have severe disease (p = 0.0011). In multivariate logistic regression model, CAR-T infusion within 6 months (relative risk (RR) 40.92; confidence interval (CI) 4.03-415.89; p = 0.002) were associated with significantly higher risk of severe disease. CONCLUSION Through this study, we conclude that the outcome for B-cell lymphoma patients following CD19 targeted CAR-T therapy when facing omicron infection was improved, but aggressive precautionary measures were particularly crucial for patients with high risk factors.
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Affiliation(s)
- Xibin Xiao
- Department of Hematology, The Second Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Panpan Chen
- Department of Hematology, The Second Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Yadi Zhong
- Department of Bio‐TherapeuticThe First Medical Centre, Chinese People's Liberation Army General HospitalBeijingChina
| | - Xiu Luo
- Department of Hematology, Tongji HospitalTongji University School of MedicineShanghaiChina
| | - Yao Liu
- Department of Hematology OncologyChongqing University Cancer HospitalChongqingChina
| | - Ying Lu
- Department of Hematology, Yinzhou Hospital, Affiliated to College of MedicineNingbo UniversityNingboChina
| | - Xueli Jin
- Department of Hematology, The Second Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
| | - Weidong Han
- Department of Bio‐TherapeuticThe First Medical Centre, Chinese People's Liberation Army General HospitalBeijingChina
| | - Aibin Liang
- Department of Hematology, Tongji HospitalTongji University School of MedicineShanghaiChina
| | - Hui Liu
- Department of Hematology, The Second Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina
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5
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Rivas-Macho A, Eletxigerra U, Diez-Ahedo R, Barros Á, Merino S, Goñi-de-Cerio F, Olabarria G. Development of an Electrochemical Sensor for SARS-CoV-2 Detection Based on Loop-Mediated Isothermal Amplification. BIOSENSORS 2023; 13:924. [PMID: 37887117 PMCID: PMC10605850 DOI: 10.3390/bios13100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused more than 6 million deaths all over the world, demonstrating the need for a simple, fast and cost-effective point-of-care (POC) test for the detection of the virus. In this work, we developed an electrochemical sensor for SARS-CoV-2 virus detection on clinical samples based on loop-mediated isothermal amplification (LAMP). With the development of this novel sensor, the time of each measurement is significantly reduced by avoiding the DNA extraction step and replacing it with inactivation of the sample by heating it at 95 °C for 10 min. To make the reaction compatible with the sample pre-treatment, an RNase inhibitor was added directly to the premix. The LAMP product was measured in a novel, easy-to-use manufactured sensor containing a custom-made screen-printed carbon electrode. Electrochemical detection was performed with a portable potentiostat, and methylene blue was used as the redox-transducing molecule. The developed sensor achieved a limit of detection of 62 viral copies and was 100% specific for the detection of the SARS-CoV-2 virus. The performance of the electrochemical sensor was validated with nasopharyngeal samples, obtaining a sensibility and specificity of 100% compared to the gold standard RT-PCR method.
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Affiliation(s)
- Ane Rivas-Macho
- Gaiker, GAIKER Technology Centre, Basque Research and Technology Alliance, 48170 Zamudio, Spain
- Molecular Biology and Biomedicine PhD Program, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Unai Eletxigerra
- Surface Chemistry and Nanotechnologies Unit, Tekniker, 20600 Eibar, Spain
| | - Ruth Diez-Ahedo
- Surface Chemistry and Nanotechnologies Unit, Tekniker, 20600 Eibar, Spain
| | - Ángela Barros
- Surface Chemistry and Nanotechnologies Unit, Tekniker, 20600 Eibar, Spain
| | - Santos Merino
- Surface Chemistry and Nanotechnologies Unit, Tekniker, 20600 Eibar, Spain
- Electricity and Electronics Department, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Felipe Goñi-de-Cerio
- Gaiker, GAIKER Technology Centre, Basque Research and Technology Alliance, 48170 Zamudio, Spain
| | - Garbiñe Olabarria
- Gaiker, GAIKER Technology Centre, Basque Research and Technology Alliance, 48170 Zamudio, Spain
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Wang Y, Wei J, Gao CX, Jin T, Liu L. Tracing the origin of large respiratory droplets by their deposition characteristics inside the respiratory tract during speech. BUILDING SIMULATION 2023; 16:781-794. [PMID: 37101943 PMCID: PMC10009356 DOI: 10.1007/s12273-022-0982-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 05/28/2023]
Abstract
Origin of differently sized respiratory droplets is fundamental for clarifying their viral loads and the sequential transmission mechanism of SARS-CoV-2 in indoor environments. Transient talking activities characterized by low (0.2 L/s), medium (0.9 L/s), and high (1.6 L/s) airflow rates of monosyllabic and successive syllabic vocalizations were investigated by computational fluid dynamics (CFD) simulations based on a real human airway model. SST k-ω model was chosen to predict the airflow field, and the discrete phase model (DPM) was used to calculate the trajectories of droplets within the respiratory tract. The results showed that flow field in the respiratory tract during speech is characterized by a significant laryngeal jet, and bronchi, larynx, and pharynx-larynx junction were main deposition sites for droplets released from the lower respiratory tract or around the vocal cords, and among which, over 90% of droplets over 5 µm released from vocal cords deposited at the larynx and pharynx-larynx junction. Generally, droplets' deposition fraction increased with their size, and the maximum size of droplets that were able to escape into external environment decreased with the airflow rate. This threshold size for droplets released from the vocal folds was 10-20 µm, while that for droplets released from the bronchi was 5-20 µm under various airflow rates. Besides, successive syllables pronounced at low airflow rates promoted the escape of small droplets, but do not significantly affect the droplet threshold diameter. This study indicates that droplets larger than 20 µm may entirely originate from the oral cavity, where viral loads are lower; it provides a reference for evaluating the relative importance of large-droplet spray and airborne transmission route of COVID-19 and other respiratory infections.
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Affiliation(s)
- Yihan Wang
- Institute of Refrigeration and Cryogenics, Key Laboratory of Refrigeration and Cryogenic Technology of Zhejiang Province, Zhejiang University, Hangzhou, 310000 China
| | - Jianjian Wei
- Institute of Refrigeration and Cryogenics, Key Laboratory of Refrigeration and Cryogenic Technology of Zhejiang Province, Zhejiang University, Hangzhou, 310000 China
| | - Caroline X. Gao
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Tao Jin
- Institute of Refrigeration and Cryogenics, Key Laboratory of Refrigeration and Cryogenic Technology of Zhejiang Province, Zhejiang University, Hangzhou, 310000 China
| | - Li Liu
- Department of Building Science, Tsinghua University, Beijing, 100084 China
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Embregts CWE, Farag EABA, Bansal D, Boter M, van der Linden A, Vaes VP, van Middelkoop-van den Berg I, IJpelaar J, Ziglam H, Coyle PV, Ibrahim I, Mohran KA, Alrajhi MMS, Islam MM, Abdeen R, Al-Zeyara AA, Younis NM, Al-Romaihi HE, AlThani MHJ, Sikkema RS, Koopmans MPG, Oude Munnink BB, GeurtsvanKessel CH. Rabies Virus Populations in Humans and Mice Show Minor Inter-Host Variability within Various Central Nervous System Regions and Peripheral Tissues. Viruses 2022; 14:v14122661. [PMID: 36560665 PMCID: PMC9781572 DOI: 10.3390/v14122661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Rabies virus (RABV) has a broad host range and infects multiple cell types throughout the infection cycle. Next-generation sequencing (NGS) and minor variant analysis are powerful tools for studying virus populations within specific hosts and tissues, leading to novel insights into the mechanisms of host-switching and key factors for infecting specific cell types. In this study we investigated RABV populations and minor variants in both original (non-passaged) samples and in vitro-passaged isolates of various CNS regions (hippocampus, medulla oblongata and spinal cord) of a fatal human rabies case, and of multiple CNS and non-CNS tissues of experimentally infected mice. No differences in virus populations were detected between the human CNS regions, and only one non-synonymous single nucleotide polymorphism (SNP) was detected in the fifth in vitro passage of virus isolated from the spinal cord. However, the appearance of this SNP shows the importance of sequencing newly passaged virus stocks before further use. Similarly, we did not detect apparent differences in virus populations isolated from different CNS and non-CNS tissues of experimentally infected mice. Sequencing of viruses obtained from pharyngeal swab and salivary gland proved difficult, and we propose methods for improving sampling.
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Affiliation(s)
- Carmen W. E. Embregts
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
- Correspondence:
| | | | | | - Marjan Boter
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Anne van der Linden
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Vincent P. Vaes
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
| | | | - Jeroen. IJpelaar
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Hisham Ziglam
- Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | | | - Imad Ibrahim
- Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
- Biomedical Research Centre, Qatar University, Doha P.O. Box 2713, Qatar
| | - Khaled A. Mohran
- Department of Animal Resources, Ministry of Municipality, Doha P.O. Box 35081, Qatar
- Biotechnology Departments ERC, Animal Health Research Institute, Dokki 12611, Egypt
| | | | - Md. Mazharul Islam
- Department of Animal Resources, Ministry of Municipality, Doha P.O. Box 35081, Qatar
| | - Randa Abdeen
- Department of Animal Resources, Ministry of Municipality, Doha P.O. Box 35081, Qatar
| | - Abdul Aziz Al-Zeyara
- Department of Animal Resources, Ministry of Municipality, Doha P.O. Box 35081, Qatar
| | - Nidal Mahmoud Younis
- Department of Animal Resources, Ministry of Municipality, Doha P.O. Box 35081, Qatar
| | | | | | - Reina S. Sikkema
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Marion P. G. Koopmans
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Bas B. Oude Munnink
- Department of Viroscience, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
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8
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Pratelli A, Pellegrini F, Ceci L, Tatò D, Lucente MS, Capozzi L, Camero M, Buonavoglia A. Severe acute respiratory syndrome coronavirus 2 detection by real time polymerase chain reaction using pooling strategy of nasal samples. Front Microbiol 2022; 13:957957. [PMID: 35958156 PMCID: PMC9361001 DOI: 10.3389/fmicb.2022.957957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19 is a life-threatening multisistemic infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection control relies on timely identification and isolation of infected people who can alberg the virus for up to 14 days, providing important opportunities for undetected transmission. This note describes the application of rRT-PCR test for simpler, faster and less invasive monitoring of SARS-CoV-2 infection using pooling strategy of samples. Seventeen positive patients were provided with sterile dry swabs and asked to self-collected 2 nasal specimens (#NS1 and #NS2). The #NS1 was individually placed in a single tube and the #NS2 was placed in another tube together with 19 NSs collected from 19 negative patients. Both tubes were then tested with conventional molecular rRT-PCR and the strength of pooling nasal testing was compared with the molecular test performed on the single NS of each positive patient. The pooling strategy detected SARS-CoV-2 RNA to a similar extent to the single test, even when Ct value is on average high (Ct 37–38), confirming that test sensibility is not substantially affected even if the pool contains only one low viral load positive sample. Furthermore, the pooling strategy have benefits for SARS-CoV-2 routinary monitoring of groups in regions with a low SARS-CoV-2 prevalence.
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Affiliation(s)
- Annamaria Pratelli
- Department of Veterinary Medicine, University Aldo Moro of Bari, Valenzano, Italy
- *Correspondence: Annamaria Pratelli,
| | - Francesco Pellegrini
- Department of Veterinary Medicine, University Aldo Moro of Bari, Valenzano, Italy
| | - Luigi Ceci
- Clinical Pathology and Microbiology, Hospital Bonomo, Andria, Italy
| | - Daniela Tatò
- Clinical Pathology, Hospital Monsignor Dimiccoli, Barletta, Italy
| | - Maria Stella Lucente
- Department of Veterinary Medicine, University Aldo Moro of Bari, Valenzano, Italy
| | - Loredana Capozzi
- Istituto Zooprofilattico Sperimentale di Puglia e Basilicata, Putignano, Italy
| | - Michele Camero
- Department of Veterinary Medicine, University Aldo Moro of Bari, Valenzano, Italy
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Stettler MEJ, Nishida RT, de Oliveira PM, Mesquita LCC, Johnson TJ, Galea ER, Grandison A, Ewer J, Carruthers D, Sykes D, Kumar P, Avital E, Obeysekara AIB, Doorly D, Hardalupas Y, Green DC, Coldrick S, Parker S, Boies AM. Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets. ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 35592762 DOI: 10.6084/m9.figshare.c.5958950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.
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Affiliation(s)
- Marc E J Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Robert T Nishida
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8
| | | | - Léo C C Mesquita
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Tyler J Johnson
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Edwin R Galea
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - Angus Grandison
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - John Ewer
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - David Carruthers
- Cambridge Environmental Research Consultants Ltd, 3 Kings Parade, Cambridge CB2 1SJ, UK
| | | | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eldad Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Asiri I B Obeysekara
- Applied Modelling and Computation Group, Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK
| | - Denis Doorly
- Department of Aeronautics, Imperial College London, London SW7 2AZ, UK
| | - Yannis Hardalupas
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - David C Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
| | - Simon Coldrick
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire SK17 9JN UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| | - Adam M Boies
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
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Stettler MEJ, Nishida RT, de Oliveira PM, Mesquita LCC, Johnson TJ, Galea ER, Grandison A, Ewer J, Carruthers D, Sykes D, Kumar P, Avital E, Obeysekara AIB, Doorly D, Hardalupas Y, Green DC, Coldrick S, Parker S, Boies AM. Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets. ROYAL SOCIETY OPEN SCIENCE 2022; 9:212022. [PMID: 35592762 PMCID: PMC9066307 DOI: 10.1098/rsos.212022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 05/03/2023]
Abstract
There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.
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Affiliation(s)
- Marc E. J. Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Robert T. Nishida
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8
| | | | - Léo C. C. Mesquita
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Tyler J. Johnson
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Edwin R. Galea
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - Angus Grandison
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - John Ewer
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - David Carruthers
- Cambridge Environmental Research Consultants Ltd, 3 Kings Parade, Cambridge CB2 1SJ, UK
| | | | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eldad Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Asiri I. B. Obeysekara
- Applied Modelling and Computation Group, Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK
| | - Denis Doorly
- Department of Aeronautics, Imperial College London, London SW7 2AZ, UK
| | - Yannis Hardalupas
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - David C. Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
| | - Simon Coldrick
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire SK17 9JN UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| | - Adam M. Boies
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
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Kim DH, Kim D, Moon JW, Chae SW, Rhyu IJ. Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge. J Korean Med Sci 2022; 37:e88. [PMID: 35315599 PMCID: PMC8938608 DOI: 10.3346/jkms.2022.37.e88] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
Nasopharyngeal swabs have been widely to prevent the spread of coronavirus disease 2019 (COVID-19). Nasopharyngeal COVID-19 testing is a generally safe and well-tolerated procedure, but numerous complications have been reported in the media. Therefore, the present study aimed to review and document adverse events and suggest procedural references to minimize preventable but often underestimated risks. A total of 27 articles were selected for the review of 842 related documents in PubMed, Embase, and KoreaMed. The complications related to nasopharyngeal COVID-19 testing were reported to be rarely happened, ranging from 0.0012 to 0.026%. Frequently documented adverse events were retained swabs, epistaxis, and cerebrospinal fluid leakage, often associated with high-risk factors, including severe septal deviations, pre-existing skull base defects, and previous sinus or transsphenoidal pituitary surgery. Appropriate techniques based on sufficient anatomical knowledge are mandatory for clinicians to perform nasopharyngeal COVID-19 testing. The nasal floor can be predicted by the line between the nostril and external ear canal. For safe testing, the angle of swab insertion in the nasal passage should remain within 30° of the nasal floor. The swab was gently inserted along the nasal septum just above the nasal floor to the nasopharynx and remained on the nasopharynx for several seconds before removal. Forceful insertion should be attempted, and alternative examinations should be considered, especially in vulnerable patients. In conclusion, patients and clinicians should be aware of rare but possible complications and associated high-risk factors. The suggested procedural pearls enable more comfortable and safe nasopharyngeal COVID-19 testing for both clinicians and patients.
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Affiliation(s)
- Dai Hyun Kim
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Dasom Kim
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Jee Won Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Korea
| | - Sung-Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University Medicine, Seoul, Korea.
| | - Im Joo Rhyu
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
- Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, Seoul, Korea.
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Pinilla YT, Friessinger E, Griesbaum JM, Berner L, Heinzel C, Elsner K, Fendel R, Held J, Kreidenweiss A. Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy). JMIR Res Protoc 2021; 10:e27739. [PMID: 34533472 PMCID: PMC8510152 DOI: 10.2196/27739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. OBJECTIVE This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. METHODS SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2-antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). RESULTS The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. CONCLUSIONS Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2-antibody measurement allows for a unique, representative, population-based sample collection process. TRIAL REGISTRATION ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27739.
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Affiliation(s)
- Yudi T Pinilla
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Evelyn Friessinger
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Lilith Berner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Constanze Heinzel
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Käthe Elsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Rolf Fendel
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jana Held
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, partner site Tübingen, Tübingen, Germany
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13
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Huang L. Computed tomography-positive, SARS-CoV-2 RNA-negative symptomatic contacts of COVID-19 patients: what are their nature and implications? Future Virol 2021; 16:10.2217/fvl-2021-0205. [PMID: 34650618 PMCID: PMC8500462 DOI: 10.2217/fvl-2021-0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Lei Huang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
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14
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Huang L, Zhang X, Zhang L, Xu J, Wei Z, Xu Y, Zhang C, Xu A. Swab and Sputum SARS-CoV-2 RNA-Negative, CT-Positive, Symptomatic Contacts of COVID-19 Cases: A Hypothesis-Generating Prospective Population-Based Cohort Study of Eight Clusters. Front Med (Lausanne) 2021; 8:685544. [PMID: 34485329 PMCID: PMC8416039 DOI: 10.3389/fmed.2021.685544] [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: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 01/19/2023] Open
Abstract
Background: While some contacts of COVID-19 cases become symptomatic and radiographically abnormal, their SARS-CoV-2 RNA tests remain negative throughout the disease course. This prospective population-based cohort study aimed to explore their characteristics and significances. Methods: From January 22, 2020, when the first COVID-19 case was identified in Hefei, China, until July 3, a total of 14,839 people in Feidong, Hefei, with a population of ~1,081,000 underwent SARS-CoV-2 RNA testing, where 36 cases (0.2%) with confirmed COVID-19 infection (Group 1) and 27 close contacts (0.2%) testing negative for SARS-CoV-2 RNA but having both positive COVID-19 exposure histories and CT findings (Group 2) from eight clusters were prospectively identified. Another 62 non-COVID-19 pneumonia cases without any exposure history (Group 3) were enrolled, and characteristics of the three groups were described and compared. We further described a cluster with an unusual transmission pattern. Results: Fever was more common in Group 2 than Groups 1 and 3. Frequency of diarrhea in Group 1 was higher than in Groups 2 and 3. Median leucocyte, neutrophil, monocyte, and eosinophil counts were all lower in Groups 1 and 2 than in Group 3. Median D-dimer level was lower in Group 1 than in Groups 2 and 3. Total protein and albumin levels were higher in Groups 1 and 2 than in Group 3. C-reactive protein level was lower and erythrocyte sedimentation rate slower in Groups 1 and 2 than in Group 3. Combination antibacterial therapy and levofloxacin were more often used in Group 3 than in Groups 1 and 2. Lopinavir/ritonavir was more often administered in Groups 1 and 2 than in Group 3. Group 1 received more often corticosteroids than Groups 2 and 3. Group 2 received less often oxygen therapy than Groups 1 and 3. Median duration from illness onset to discharge was longer in Group 1 (27 d) than Groups 2 and 3 (both 17 d). Among contacts of a confirmed COVID-19 patient, only one had a positive virus RNA test but remained asymptomatic and had negative CT findings, and three had negative virus RNA tests but had symptoms and positive CT findings, one of whom transmitted COVID-19 to another asymptomatic laboratory-confirmed patient who had no other exposures. Conclusions: Among close contacts of confirmed COVID-19 cases, some present with positive symptoms and CT findings but test negative for SARS-CoV-2 RNA using common respiratory (throat swab and sputum) specimens; they have features more similar to confirmed COVID-19 cases than non-COVID-19 pneumonia cases and might have transmitted SARS-CoV-2 to others. Such cases might add to the complexity and difficulty of COVID-19 control. Our hypothesis-generating study might suggest that SARS-CoV-2 RNA testing by rRT-PCR assays of common respiratory (throat swab and sputum) specimens alone, the widely accepted "golden standard" for diagnosing COVID-19, might be sometimes insufficient, and that further studies with some further procedures (e.g., testing via bronchoalveolar lavage or specific antibodies) would be warranted for Group 2-like patients, namely, the SARS-CoV-2 RNA-negative (tested using common respiratory specimens), radiographically positive, symptomatic contacts of COVID-19 cases, to further reveal their nature.
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Affiliation(s)
- Lei Huang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiuwen Zhang
- Quarantine Ward for Respiratory Infectious Diseases, Feidong People's Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Graduate School, Soochow University, Suzhou, China
| | - Lingli Zhang
- Quarantine Ward for Respiratory Infectious Diseases, Feidong People's Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Xu
- Quarantine Ward for Respiratory Infectious Diseases, Feidong People's Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhijian Wei
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanhong Xu
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chengyuan Zhang
- Department of Respiratory and Critical Care Medicine, Feidong People's Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Aman Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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