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Di Domenico M, Serretiello E, Smimmo A, Vieira e Silva FF, Raimondi SA, Pascariello C, Marino MM, Lo Muzio L, Caponio VCA, Cantore S, Ballini A. Monitoring of Immune Memory by Phenotypical Lymphocyte Subsets Identikit: An Observational Study in a Blood Donors' Cohort. J Pers Med 2024; 14:733. [PMID: 39063987 PMCID: PMC11277854 DOI: 10.3390/jpm14070733] [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: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
The cross-talk between the innate and adaptive immune response represents the first defense weapon against the threat of pathogens. Substantial evidence has shown a relationship between immune phenotype lymphocytes and COVID-19 disease severity and/or implication in susceptibility to SARS-CoV-2 infection. Recently, belonging to ABO blood groups has been investigated as a correlation factor to COVID-19 disease. This pilot study investigated lymphocyte typing in a cohort of blood donors to understand the underlying mechanism in SARS-CoV-2 infection linked to the blood group. The study cohort consisted of 20-64-year-old subjects, without comorbidities, from both sexes, who were COVID-19 vaccinated with previous or no infection history. Whole blood samples, collected at A.O.R.N. Sant'Anna and San Sebastiano Hospital (Campania Region), were processed by multiparametric cytofluorimetric assay, to characterize CD4+ helper and CD8+ cytotoxic T cell CD3+ subpopulations. The CD45RA, CCR7, CD27, CD28, CD57 and PD-1 markers were investigated to delineate the peripheral T-cell maturation stages. Differences were detected in ABO blood types in CD3+, CD4+ gated on CD3+, CD8+ and CD8+ gated on CD3+ percentage. These results contribute to identifying a memory cell "identikit" profile in COVID-19 disease, thus leading to a useful tool in precision medicine.
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Affiliation(s)
- Marina Di Domenico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
| | - Enrica Serretiello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
- Clinical Pathology and Microbiology Unit, San Giovanni di Dio and Ruggi D’Aragona University Hospital, 84131 Salerno, Italy
| | - Annafrancesca Smimmo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
| | - Fábio França Vieira e Silva
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
| | - Sonia Anna Raimondi
- Azienda Ospedaliera “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy; (S.A.R.); (C.P.)
| | - Caterina Pascariello
- Azienda Ospedaliera “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy; (S.A.R.); (C.P.)
| | - Maria Michela Marino
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (L.L.M.); (V.C.A.C.)
| | - Vito Carlo Alberto Caponio
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (L.L.M.); (V.C.A.C.)
| | - Stefania Cantore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
| | - Andrea Ballini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.D.D.); (E.S.); (A.S.); (F.F.V.e.S.); (M.M.M.); (A.B.)
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (L.L.M.); (V.C.A.C.)
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Antonelli A, Bennardo F, Giudice A. Breakthroughs in Oral and Maxillofacial Surgery. J Clin Med 2024; 13:685. [PMID: 38337379 PMCID: PMC10856085 DOI: 10.3390/jcm13030685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
In the field of oral and maxillofacial surgery, continuous advances have ushered in a new era of innovation, profoundly influencing this branch of medicine [...].
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Affiliation(s)
- Alessandro Antonelli
- School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (A.G.)
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Bizzoca ME, Leuci S, Mignogna MD, Muzio EL, Caponio VCA, Muzio LL. Natural compounds may contribute in preventing SARS-CoV-2 infection: a narrative review. FOOD SCIENCE AND HUMAN WELLNESS 2022; 11:1134-1142. [PMID: 38621001 PMCID: PMC9160299 DOI: 10.1016/j.fshw.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronavirus pandemic infection is the most important health issue worldwide. Coronavirus disease 2019 is a contagious disease characterized by severe acute respiratory syndrome coronavirus 2. To date, excluding the possibility of vaccination, against SARS-CoV-2 infection it is possible to act only with supportive care and non-virus-specific treatments in order to improve the patient's symptoms. Pharmaceutical industry is investigating effects of medicinal plants, phytochemical extracts and aromatic herbs to find out natural substances which may act as antiviral drugs. Several studies have revealed how these substances may interfere with the viral life cycle, viral entry, replication, assembly or discharge, as well as virus-specific host targets or stimulating the host immune system, reducing oxidative stress and inflammatory response. A natural compound can be used as a prophylaxis by people professionally exposed to the risk of contagion and/or positive patients not in intensive care. The aim of this paper is to perform a narrative review of current literature in order to summarize the most studied natural compounds and their modes of action.
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Affiliation(s)
- Maria Eleonora Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Stefania Leuci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples 80131, Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples 80131, Italy
| | - Eleonora Lo Muzio
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
- C.I.N.B.O. (Consorzio Interuniversitario Nazionale per la Bio-Oncologia), Chieti 66100, Italy
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Kumar M, Jiang G, Kumar Thakur A, Chatterjee S, Bhattacharya T, Mohapatra S, Chaminda T, Kumar Tyagi V, Vithanage M, Bhattacharya P, Nghiem LD, Sarkar D, Sonne C, Mahlknecht J. Lead time of early warning by wastewater surveillance for COVID-19: Geographical variations and impacting factors. CHEMICAL ENGINEERING JOURNAL (LAUSANNE, SWITZERLAND : 1996) 2022; 441:135936. [PMID: 35345777 PMCID: PMC8942437 DOI: 10.1016/j.cej.2022.135936] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/07/2022] [Accepted: 03/19/2022] [Indexed: 05/05/2023]
Abstract
The global data on the temporal tracking of the COVID-19 through wastewater surveillance needs to be comparatively evaluated to generate a proper and precise understanding of the robustness, advantages, and sensitivity of the wastewater-based epidemiological (WBE) approach. We reviewed the current state of knowledge based on several scientific articles pertaining to temporal variations in COVID-19 cases captured via viral RNA predictions in wastewater. This paper primarily focuses on analyzing the WBE-based temporal variation reported globally to check if the reported early warning lead-time generated through environmental surveillance is pragmatic or latent. We have compiled the geographical variations reported as lead time in various WBE reports to strike a precise correlation between COVID-19 cases and genome copies detected through wastewater surveillance, with respect to the sampling dates, separately for WASH and non-WASH countries. We highlighted sampling methods, climatic and weather conditions that significantly affected the concentration of viral SARS-CoV-2 RNA detected in wastewater, and thus the lead time reported from the various climatic zones with diverse WASH situations were different. Our major findings are: i) WBE reports around the world are not comparable, especially in terms of gene copies detected, lag-time gained between monitored RNA peak and outbreak/peak of reported case, as well as per capita RNA concentrations; ii) Varying sanitation facility and climatic conditions that impact virus degradation rate are two major interfering features limiting the comparability of WBE results, and iii) WBE is better applicable to WASH countries having well-connected sewerage system.
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Affiliation(s)
- Manish Kumar
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
| | - Guangming Jiang
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, Australia
| | - Alok Kumar Thakur
- Discipline of Earth Science, Indian Institute of Technology Gandhinagar, Gujarat 382 355, India
| | - Shreya Chatterjee
- Encore Insoltech Pvt Ltd, Randesan, Gandhinagar, Gujarat 382 307, India
| | - Tanushree Bhattacharya
- Department of Civil and Environmental Engineering, Birla Institute of Technology, Mesra 835215, India
| | - Sanjeeb Mohapatra
- NUS Environmental Research Institute, National University of Singapore, Singapore
| | - Tushara Chaminda
- Department of Civil and Environmental Engineering, University of Ruhuna, Sri Lanka
| | - Vinay Kumar Tyagi
- Environmental BioTechnology Group (EBiTG), Department of Civil Engineering, Indian Institute of Technology Roorkee, Uttarakhand, India
| | - Meththika Vithanage
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Prosun Bhattacharya
- COVID-19 Research@KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology,SE-100 44, Stockholm, Sweden
| | - Long D Nghiem
- Centre for Technology in Water & Wastewater, University of Technology Sydney, Ultimo 2007, Australia
| | - Dibyendu Sarkar
- Department of Civil, Environmental and Ocean Engineering, Stevens Institute of Technology, NJ 07030, USA
| | - Christian Sonne
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
- Department of Ecoscience, Aarhus University, Roskilde DK-4000, Denmark
| | - Jürgen Mahlknecht
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Campus Monterey, Monterrey 64849, Nuevo Leon, Mexico
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Kukull B, Shakir SM, Hanson KE. Performance of Non-Nasopharyngeal Sample Types for Molecular Detection of SARS-CoV-2. Clin Lab Med 2022; 42:249-259. [PMID: 35636825 PMCID: PMC8860668 DOI: 10.1016/j.cll.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Lee BE, Sikora C, Faulder D, Risling E, Little LA, Qiu Y, Gao T, Bulat R, Craik S, Hrudey SE, Ohinmaa A, Estabrooks CA, Gingras AC, Charlton C, Kim J, Wood H, Robinson A, Kanji JN, Zelyas N, O'Brien SF, Drews S, Pang XL. Early warning and rapid public health response to prevent COVID-19 outbreaks in long-term care facilities (LTCF) by monitoring SARS-CoV-2 RNA in LTCF site-specific sewage samples and assessment of antibodies response in this population: prospective study protocol. BMJ Open 2021; 11:e052282. [PMID: 34417219 PMCID: PMC8382669 DOI: 10.1136/bmjopen-2021-052282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has an excessive impact on residents in long-term care facilities (LTCF), causing high morbidity and mortality. Early detection of presymptomatic and asymptomatic COVID-19 cases supports the timely implementation of effective outbreak control measures but repetitive screening of residents and staff incurs costs and discomfort. Administration of vaccines is key to controlling the pandemic but the robustness and longevity of the antibody response, correlation of neutralising antibodies with commercial antibody assays, and the efficacy of current vaccines for emerging COVID-19 variants require further study. We propose to monitor SARS-CoV-2 in site-specific sewage as an early warning system for COVID-19 in LTCF and to study the immune response of the staff and residents in LTCF to COVID-19 vaccines. METHODS AND ANALYSIS The study includes two parts: (1) detection and quantification of SARS-CoV-2 in LTCF site-specific sewage samples using a molecular assay followed by notification of Public Health within 24 hours as an early warning system for appropriate outbreak investigation and control measures and cost-benefit analyses of the system and (2) testing for SARS-CoV-2 antibodies among staff and residents in LTCF at various time points before and after COVID-19 vaccination using commercial assays and neutralising antibody testing performed at a reference laboratory. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Alberta Health Research Ethics Board with considerations to minimise risk and discomforts for the participants. Early recognition of a COVID-19 case in an LTCF might prevent further transmission in residents and staff. There was no direct benefit identified to the participants of the immunity study. Anticipated dissemination of information includes a summary report to the immunity study participants, sharing of study data with the scientific community through the Canadian COVID-19 Immunity Task Force, and prompt dissemination of study results in meeting abstracts and manuscripts in peer-reviewed journals.
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Affiliation(s)
- Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women & Children's Health Research Institute, Li Ka Shing Institute of Virology, Edmonton, Alberta, Canada
| | - Christopher Sikora
- Medical Officer of Health (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Faulder
- Medical Director, Continuing Care (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Eleanor Risling
- Executive Director, Continuing Care (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
| | - Lorie A Little
- Director, Facility and Supportive Living (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Ross Bulat
- EPCOR Water Services Inc, Edmonton, Alberta, Canada
| | | | - Steve E Hrudey
- Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Public Health Laboratory; Li Ka Shing Institute of Virology, Alberta Health Services, Edmonton, Alberta, Canada
| | - John Kim
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Heidi Wood
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | | | - Jamil N Kanji
- Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nathan Zelyas
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Public Health Laboratory, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Drews
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Public Health Laboratory; Li Ka Shing Institute of Virology, Alberta Health Services, Edmonton, Alberta, Canada
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Lim AY, Cheong HK, Oh YJ, Lee JK, So JB, Kim HJ, Han B, Park SW, Jang Y, Yoon CY, Park YO, Kim JH, Kim JY. Modeling the early temporal dynamics of viral load in respiratory tract specimens of COVID-19 patients in Incheon, the Republic of Korea. Int J Infect Dis 2021; 108:428-434. [PMID: 34058374 PMCID: PMC8161782 DOI: 10.1016/j.ijid.2021.05.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
Objective To investigate the duration and peak of severe acute respiratory syndrome coronavirus 2 shedding as infectivity markers for determining the isolation period. Methods A total of 2,558 upper respiratory tract (URT) and lower respiratory tract (LRT) specimens from 138 patients with laboratory-confirmed coronavirus disease were analyzed. Measurements of sequential viral loads were aggregated using the cubic spline smoothing function of a generalized additive model. The time to negative conversion was compared between symptom groups using survival analysis. Results In URT samples, viral RNA levels peaked on day 4 after symptom onset and rapidly decreased until day 10 for both E and RdRp genes, whereas those in LRT samples immediately peaked from symptom onset and decreased until days 15.6 and 15.0 for E and RdRp genes, respectively. Median (interquartile range) time to negative conversion was significantly longer in symptomatic (18.0 [13.0–25.0] days) patients than in asymptomatic (13.0 [9.5–17.5] days) patients. The more types of symptoms a patient had, the longer the time to negative conversion. Conclusions The viral load rapidly changes depending on the time after symptom onset; the viral shedding period may be longer with more clinical symptoms. Different isolation policies should be applied depending on disease severity.
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Affiliation(s)
- Ah-Young Lim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Yoon Ju Oh
- Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Jae Kap Lee
- Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Jae Bum So
- Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Boram Han
- Department of Neurosurgery, Incheon Medical Center, Incheon, Republic of Korea
| | - Sung Won Park
- Department of Surgery, Incheon Medical Center, Incheon, Republic of Korea
| | - Yongsun Jang
- Department of Surgery, Incheon Medical Center, Incheon, Republic of Korea
| | - Chang Yong Yoon
- Department of Anesthesiology and Pain Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Yun Ok Park
- Department of Anesthesiology and Pain Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Jong-Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
| | - Jin Yong Kim
- Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea.
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Salas Orozco MF, Niño-Martínez N, Martínez-Castañón GA, Patiño Marín N, Sámano Valencia C, Dipp Velázquez FA, Sosa Munguía PDC, Casillas Santana MA. Presence of SARS-CoV-2 and Its Entry Factors in Oral Tissues and Cells: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:523. [PMID: 34070998 PMCID: PMC8224617 DOI: 10.3390/medicina57060523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 01/07/2023]
Abstract
Background and Objectives: The aim of this systematic review is to summarize the current data about the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its entry factors in oral tissues and cells. Materials and Methods: This systematic review was carried out based on the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA). Three databases were analyzed (Pubmed, Web of science and Scopus) by three independent researchers. From the 18 identified studies, 10 of them met the inclusion criteria. The presence of SARS-CoV-2 or its entry factors (angiotensin-converting enzyme II (ACE2), transmembrane serine proteases (TMPRSS), and furin) was analyzed in these 10 studies during the pandemic. Results: ACE2 expression was analyzed in 9 of the 10 studies. ACE2 is expressed mainly in the tongue, oral mucosa, salivary glands and epithelial cells. The expression of the TMPRSS2 gene or protein was analyzed in 6 studies. These studies reported that the expression of TMPRSS2 was mainly in the salivary glands, tongue, sulcular epithelium and oral mucosa; as well as in cells of the salivary glands (ductal, acinar and myoepithelial cells) and the tongue (the spinous-based cell layer, horny layer and the epithelial surface). Other TMPRSS were also reported. The expression of TMPRSS3, TMPRSS4, TMPRSS5, TMPRSS7 and TMPRSS11D was reported mainly in salivary glands and in epithelial-type cells. Furan expression was analyzed in three studies. The expression of furin was detected mainly in epithelial cells of the tongue. A variety of methods were used to carry out the detection of SARS-CoV-2 or its input molecules. Conclusions: These results show that SARS-CoV-2 can infect a wide variety of oral tissues and cells, and that together with the theories dedicated to explaining the oral symptoms present in SARS-CoV-2 positive patients, it provides us with a good scientific basis for understanding the virus infection in the oral cavity and its consequences.
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Affiliation(s)
- Marco Felipe Salas Orozco
- Doctorado en Ciencias Odontológicas, Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, San Luis Potosí C.P. 78290, Mexico;
| | - Nereyda Niño-Martínez
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, San Luis Potosí C.P. 78210, Mexico; (N.N.-M.); (G.-A.M.-C.)
| | | | - Nuria Patiño Marín
- Doctorado en Ciencias Odontológicas, Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, San Luis Potosí C.P. 78290, Mexico;
| | - Carolina Sámano Valencia
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla C.P. 72410, Mexico; (C.S.V.); (F.A.D.V.)
| | - Farid Alonso Dipp Velázquez
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla C.P. 72410, Mexico; (C.S.V.); (F.A.D.V.)
| | - Paulina del Carmen Sosa Munguía
- Residente de la Maestría en Ciencias Médicas e Investigación, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla C.P. 72410, Mexico;
| | - Miguel Angel Casillas Santana
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla C.P. 72410, Mexico; (C.S.V.); (F.A.D.V.)
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D'Aoust PM, Graber TE, Mercier E, Montpetit D, Alexandrov I, Neault N, Baig AT, Mayne J, Zhang X, Alain T, Servos MR, Srikanthan N, MacKenzie M, Figeys D, Manuel D, Jüni P, MacKenzie AE, Delatolla R. Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021. [PMID: 33508669 DOI: 10.1016/j.scitotenv.2021.145319l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and non-discriminating surveillance tool. However, their efficacy in prospectively capturing resurgences following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawa's water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 h prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 h. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.
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Affiliation(s)
- Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Elisabeth Mercier
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Danika Montpetit
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Ilya Alexandrov
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Nafisa Neault
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Aiman Tariq Baig
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Janice Mayne
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Xu Zhang
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Tommy Alain
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, Waterloo N2L 3G1, Canada
| | | | - Malcolm MacKenzie
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Daniel Figeys
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada; Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa K1N 6N5, Canada; Canadian Institute for Advanced Research, Toronto M5G 1M1, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Peter Jüni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada.
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10
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D'Aoust PM, Graber TE, Mercier E, Montpetit D, Alexandrov I, Neault N, Baig AT, Mayne J, Zhang X, Alain T, Servos MR, Srikanthan N, MacKenzie M, Figeys D, Manuel D, Jüni P, MacKenzie AE, Delatolla R. Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 770:145319. [PMID: 33508669 PMCID: PMC7826013 DOI: 10.1016/j.scitotenv.2021.145319] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 04/14/2023]
Abstract
Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and non-discriminating surveillance tool. However, their efficacy in prospectively capturing resurgences following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawa's water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 h prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 h. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.
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Affiliation(s)
- Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Elisabeth Mercier
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Danika Montpetit
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Ilya Alexandrov
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Nafisa Neault
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Aiman Tariq Baig
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Janice Mayne
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Xu Zhang
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Tommy Alain
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, Waterloo N2L 3G1, Canada
| | | | - Malcolm MacKenzie
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Daniel Figeys
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada; Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa K1N 6N5, Canada; Canadian Institute for Advanced Research, Toronto M5G 1M1, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Peter Jüni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada.
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11
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Wolfe MK, Archana A, Catoe D, Coffman MM, Dorevich S, Graham KE, Kim S, Grijalva LM, Roldan-Hernandez L, Silverman AI, Sinnott-Armstrong N, Vugia DJ, Yu AT, Zambrana W, Wigginton KR, Boehm AB. Scaling of SARS-CoV-2 RNA in Settled Solids from Multiple Wastewater Treatment Plants to Compare Incidence Rates of Laboratory-Confirmed COVID-19 in Their Sewersheds. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2021; 8:398-404. [PMID: 37566351 PMCID: PMC8056949 DOI: 10.1021/acs.estlett.1c00184] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 05/19/2023]
Abstract
Published and unpublished reports show that SARS-CoV-2 RNA in publicly owned treatment work (POTW) wastewater influent and solids is associated with new COVID-19 cases or incidence in associated sewersheds, but methods for comparing data collected from diverse POTWs to infer information about the relative incidence of laboratory-confirmed COVID-19 cases, and scaling to allow such comparisons, have not been previously established. Here, we show that SARS-CoV-2 N1 and N2 concentrations in solids normalized by concentrations of PMMoV RNA in solids can be used to compare incidence of laboratory confirmed new COVID-19 cases across POTWs. Using data collected at seven POTWs along the United States West Coast, Midwest, and East Coast serving ∼3% of the U.S. population (9 million people), we show that a 1 log change in N gene/PMMoV is associated with a 0.24 (range 0.19 to 0.29) log10 change in incidence of laboratory confirmed COVID-19. Scaling of N1 and N2 by PMMoV is consistent, conceptually, with a mass balance model relating SARS-CoV-2 RNA to the number of infected individuals shedding virus in their stool. This information should support the application of wastewater-based epidemiology to inform the response to the COVID-19 pandemic and potentially future viral pandemics.
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Affiliation(s)
- Marlene K. Wolfe
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Anand Archana
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - David Catoe
- Joint Initiative for Metrology in Biology,
SLAC National Accelerator Laboratory, Stanford, California
94305, United States
| | - Mhara M. Coffman
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Samuel Dorevich
- Division of Environmental and Occupational Health
Sciences, School of Public Health, University of Illinois,
Chicago, Illinois 60612, United States
| | - Katherine E. Graham
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Sooyeol Kim
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Lorelay Mendoza Grijalva
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Laura Roldan-Hernandez
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Andrea I. Silverman
- Department of Civil and Urban Engineering, Tandon
School of Engineering, New York University, Brooklyn, New York
11201, United States
- School of Global Public Health, New York
University, New York, New York 10003, United
States
| | - Nasa Sinnott-Armstrong
- Department of Genetics, Stanford University
School of Medicine, Stanford, California 94305, United
States
| | - Duc J. Vugia
- Infectious Diseases Branch, California
Department of Public Health, Richmond, California 94804, United
States
| | - Alexander T. Yu
- Infectious Diseases Branch, California
Department of Public Health, Richmond, California 94804, United
States
| | - Winnie Zambrana
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
| | - Krista R. Wigginton
- Department of Civil and Environmental Engineering,
University of Michigan,Ann Arbor, Michigan 48109,
United States
| | - Alexandria B. Boehm
- Department of Civil and Environmental Engineering,
Stanford University, 473 Via Ortega, Stanford, California
94305, United States
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12
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Shende P, Gaikwad P, Gandhewar M, Ukey P, Bhide A, Patel V, Bhagat S, Bhor V, Mahale S, Gajbhiye R, Modi D. Persistence of SARS-CoV-2 in the first trimester placenta leading to transplacental transmission and fetal demise from an asymptomatic mother. Hum Reprod 2021; 36:899-906. [PMID: 33346816 PMCID: PMC7799080 DOI: 10.1093/humrep/deaa367] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/06/2020] [Indexed: 01/01/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by infection of the respiratory tract by SARS-CoV-2 which survives in the tissues during the clinical course of infection but there is limited evidence on placental infection and vertical transmission of SARS-CoV-2. The impact of COVID-19 in first trimester pregnancy remains poorly understood. Moreover, how long SARS-CoV-2 can survive in placenta is unknown. Herein we report a case of a pregnant woman in the first trimester who tested positive for SARS-CoV-2 at 8 weeks of gestation although her clinical course was asymptomatic. At 13 weeks of gestation, her throat swab tested negative for SARS-CoV-2 but viral RNA was detected in the placenta and the Spike (S) proteins (S1 and S2) were immunolocalized in cytotrophoblast and syncytiotrophoblast cells of the placental villi. Histologically, the villi were generally avascular with peri-villus fibrin deposition and in some areas the syncytiotrophoblast layer appeared lysed. The decidua also had fibrin deposition with extensive leucocyte infiltration suggestive of inflammation. The SARS-CoV-2 crossed the placental barrier, as the viral RNA was detected in the amniotic fluid and the S proteins were detected in the fetal membrane. Ultrasonography revealed extensively subcutaneous edema with pleural effusion suggestive of hydrops fetalis and the absence of cardiac activity indicated fetal demise. This is the first study to provide concrete evidence of persistent placental infection of SARS-CoV-2 and its congenital transmission associated with hydrops fetalis and intrauterine fetal demise in early pregnancy.
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Affiliation(s)
- Prajakta Shende
- Department of Obstetrics and Gynecology, ESI-PGIMSR and Model Hospital Andheri, E.S.I.S. Hospital Kandivali, Mumbai, India
| | - Pradip Gaikwad
- Department of Obstetrics and Gynecology, ESI-PGIMSR and Model Hospital Andheri, E.S.I.S. Hospital Kandivali, Mumbai, India
| | - Manisha Gandhewar
- Department of Obstetrics and Gynecology, ESI-PGIMSR and Model Hospital Andheri, E.S.I.S. Hospital Kandivali, Mumbai, India
| | - Pawankumar Ukey
- Department of Microbiology, ESI-PGIMSR and Model Hospital Andheri, E.S.I.S. Hospital Kandivali, Mumbai, India
| | - Anshul Bhide
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Vainav Patel
- Department of Biochemistry, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Sharad Bhagat
- Department of Biochemistry, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Vikrant Bhor
- Department of Molecular Immunology and Microbiology, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Smita Mahale
- Director and Department of Structural Biology, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Rahul Gajbhiye
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Deepak Modi
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
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13
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Gao Y, Ding M, Dong X, Zhang J, Kursat Azkur A, Azkur D, Gan H, Sun Y, Fu W, Li W, Liang H, Cao Y, Yan Q, Cao C, Gao H, Brüggen M, Veen W, Sokolowska M, Akdis M, Akdis CA. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy 2021; 76:428-455. [PMID: 33185910 DOI: 10.1111/all.14657] [Citation(s) in RCA: 769] [Impact Index Per Article: 256.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, including old age, male gender, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases, tumors, clinically apparent immunodeficiencies, local immunodeficiencies, such as early type I interferon secretion capacity, and pregnancy. Possible complications include acute kidney injury, coagulation disorders, thoromboembolism. The development of lymphopenia and eosinopenia are laboratory indicators of COVID-19. Laboratory parameters to monitor disease progression include lactate dehydrogenase, procalcitonin, high-sensitivity C-reactive protein, proinflammatory cytokines such as interleukin (IL)-6, IL-1β, Krebs von den Lungen-6 (KL-6), and ferritin. The development of a cytokine storm and extensive chest computed tomography imaging patterns are indicators of a severe disease. In addition, socioeconomic status, diet, lifestyle, geographical differences, ethnicity, exposed viral load, day of initiation of treatment, and quality of health care have been reported to influence individual outcomes. In this review, we highlight the scientific evidence on the risk factors of severity of COVID-19.
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Affiliation(s)
- Ya‐dong Gao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Mei Ding
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Xiang Dong
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Jin‐jin Zhang
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Ahmet Kursat Azkur
- Department of Virology Faculty of Veterinary Medicine University of Kirikkale Kirikkale Turkey
| | - Dilek Azkur
- Division of Pediatric Allergy and Immunology Department of Pediatrics Faculty of Medicine University of Kirikkale Kirikkale Turkey
| | - Hui Gan
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Yuan‐li Sun
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Wei Fu
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Wei Li
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Hui‐ling Liang
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Yi‐yuan Cao
- Department of Radiology Zhongnan Hospital of Wuhan University Wuhan China
| | - Qi Yan
- Department of Geriatrics Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Huazhong China
| | - Can Cao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Hong‐yu Gao
- Department of Geriatrics Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Huazhong China
| | - Marie‐Charlotte Brüggen
- Department of Dermatology University Hospital Zurich Zurich Switzerland
- Faculty of Medicine University of Zurich Zurich Switzerland
- Hochgebirgsklinik Davos Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Willem Veen
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Zurich Switzerland
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