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Rezabakhsh A, Mojtahedi F, Tahsini Tekantapeh S, Mahmoodpoor A, Ala A, Soleimanpour H. Therapeutic Impact of Tocilizumab in the Setting of Severe COVID-19; an Updated and Comprehensive Review on Current Evidence. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2024; 12:e47. [PMID: 38994467 PMCID: PMC11239185 DOI: 10.22037/aaem.v12i1.2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Introduction The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard. Methods In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria. Results Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear. Conclusion Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians' decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.
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Affiliation(s)
- Aysa Rezabakhsh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- These authors contributed equally as the first co-authors
| | - Fatemeh Mojtahedi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- These authors contributed equally as the first co-authors
| | - Sepideh Tahsini Tekantapeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Rheumatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ala
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Husain AA, Kashyap RS. Double trouble: compounding effects of COVID-19 pandemic and antimicrobial resistance on drug resistant TB epidemiology in India. Front Public Health 2023; 11:1305655. [PMID: 38125850 PMCID: PMC10731282 DOI: 10.3389/fpubh.2023.1305655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
| | - Rajpal Singh Kashyap
- Advanced Research Center, Central India Institute of Medical Sciences, Nagpur, India
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Abhyankar M, Kadam D, Reddy PR, Siddiqui MZ, Ratheesh M, Jagmag T, Tilwani J. The Efficacy and Safety of Imusil® Tablets in the Treatment of Adult Patients With Mild COVID-19: A Prospective, Randomized, Multicenter, Open-Label Study. Cureus 2023; 15:e35881. [PMID: 37051002 PMCID: PMC10085312 DOI: 10.7759/cureus.35881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) is a serious concern of the new era. Along with antiviral synthetic medications, there is a need to discover efficacious herbal antiviral medicines with minimum side effects in patients against COVID-19. This study aimed to assess the efficacy and safety of Imusil® among patients with mild COVID-19. Methods A prospective, randomized, multicenter, open-label, interventional study was conducted in patients with mild COVID-19 infection. Patients received either Imusil one tablet four times a day (seven days) along with the standard of care (SoC) or only SoC. The study endpoints were reverse transcription-polymerase chain reaction (RT-PCR) negativity, changes in cycle threshold (CT), clinical improvement, change in blood inflammatory indexes, and safety assessment. Results A total of 100 patients were enrolled, and 98 received at least one dose of treatment. The median age of patients was 36.0 years, and 58 were males. By day 4, 85.4% of patients in the Imusil+SoC group tested negative for RT-PCR compared to 64% of patients exhibiting the same outcome in the SoC group (P=0.0156). After eight days, clinical improvement was observed in all patients from the Imusil+SoC group, while in the SoC group, clinical improvement was observed in 94.0% of patients (P=0.4947). During follow-up visits, the average C-reactive protein (CRP) levels decreased from baseline in both treatment groups. The decrease in the levels of CRP (-7.3 mg/dL versus -5.5 mg/dL), D-dimer (-231.0 ng/mL versus -151.6 ng/mL), and interleukin 6 (IL-6) (-2.3 pg/mL versus -2.0 pg/mL) at eight days was comparatively higher in the Imusil+SoC group versus the SoC group. There were no serious treatment-emergent adverse events in the drug arm. Conclusion Imusil provides effective antiviral activity and safety in mild COVID-19 patients. Imusil ensures faster RT-PCR negativity and clinical improvement and ensures effective reduction of inflammatory markers such as CRP, D-dimer and interleukin 6.
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Affiliation(s)
| | - Dilip Kadam
- Internal Medicine, Care Multispeciality Hospital, Pune, IND
| | | | | | - M Ratheesh
- Biochemistry, St. Thomas College, Kottayam, IND
| | - Tariq Jagmag
- Medical Affairs, Glowderma Lab Private Limited, Mumbai, IND
| | - Jayesh Tilwani
- Medical Affairs, Glowderma Lab Private Limited, Mumbai, IND
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Gao Q, Yin X, Tan B, Wang J, Chen J, Zhao B, Yang Q, Li Z. Drug-induced liver injury following the use of tocilizumab or sarilumab in patients with coronavirus disease 2019. BMC Infect Dis 2022; 22:929. [PMID: 36503381 PMCID: PMC9742033 DOI: 10.1186/s12879-022-07896-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUNDS Interleukin-6 (IL-6) blockers including tocilizumab and sarilumab were approved by the U.S. Food and Drug Administration (FDA) in June 2021 for the treatment of patients with moderate to severe COVID-19. The use of sarilumab or tocilizumab in COVID-19 patients has been related to a reduction in mortality compared to standard care. Recent evidence has emerged concerning drug-induced liver injury (DILI) after sarilumab or tocilizumab applications in COVID-19 patients. AIMS The study aimed to estimate DILI associated with sarilumab or tocilizumab in treating moderate to severe patients infected with SARS-Cov-2. METHODS We conducted a retrospective pharmacovigilance study by data mining of the FDA's adverse event reporting systems (FAERS) database from the first quarter of 2004 to the fourth quarter of 2021 in confirmed COVID-19 patients. We analyzed DILI cases associated with tocilizumab or sarilumab in treating COVID-19 patients from the FAERS during this period. Disproportionality analysis and Bayesian analysis of COVID-19 patients were utilized for case analysis, and we also next compared the onset time and fatality rates of DILI following tocilizumab or sarilumab. RESULTS A total of 275 cases of TCZ or SAR-related DILI reports were extracted. A total of 192 AEs cases were related to tocilizumab (TCZ), and 83 were related to sarilumab (SAR). In patients treated with TCZ, most were < 75 years old (51.57%), with more male than female (46.35% vs. 13.02%). The correlation between IL-6 receptor antagonists and DILI was stronger in SAR (ROR = 12.94; 95%CI 9.6-17.44) than in TCZ (ROR = 1.33; 95%CI 1.14-1.55). The onset time of DILI was different between TCZ and SAR, and a significant difference was observed in TCZ than SAR (P < 0.0001). A significant difference was observed in the mortality rate of TCZ and SAR (P = 0.0009). DILI associated with COVID-19 patients treated with TCZ appeared to have earlier onset-time (1(0-46) day) VS. SAR (3.5(0-27) day). CONCLUSION This study shows strict monitor ought to be paid for TCZ or SAR when used for COVID-19 patients with poor liver function.
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Affiliation(s)
- Qian Gao
- grid.16821.3c0000 0004 0368 8293Department of Pharmacy, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062 China ,grid.16821.3c0000 0004 0368 8293School of Medicine, Shanghai Jiao Tong University, Shanghai, 200125 China
| | - Xuedong Yin
- grid.16821.3c0000 0004 0368 8293Department of Pharmacy, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062 China ,grid.16821.3c0000 0004 0368 8293School of Medicine, Shanghai Jiao Tong University, Shanghai, 200125 China
| | - Boyu Tan
- grid.16821.3c0000 0004 0368 8293Department of Pharmacy, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062 China
| | - Junshi Wang
- grid.259384.10000 0000 8945 4455Macau University of Science and Technology, Macau, China
| | - Jiayan Chen
- School of Nursing and Health, Shanghai Zhongqiao Vocational and Technical University, Shanghai, 201514 China
| | - Bin Zhao
- grid.413106.10000 0000 9889 6335Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Qiaoling Yang
- grid.16821.3c0000 0004 0368 8293Department of Pharmacy, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062 China ,grid.412540.60000 0001 2372 7462Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China
| | - Zhiling Li
- grid.16821.3c0000 0004 0368 8293Department of Pharmacy, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062 China
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Surana PD, Nayak R, Sheikh A, Haldankar P, Kale J. Clinical experience of tocilizumab treatment among a cohort of patients with COVID-19 infection from Western India. J Family Med Prim Care 2022; 11:123-132. [PMID: 35309657 PMCID: PMC8930122 DOI: 10.4103/jfmpc.jfmpc_817_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 11/08/2022] Open
Abstract
Background: Initiation of tocilizumab (TCZ) treatment in patients with coronavirus disease 2019 (COVID-19) during the early phases of cytokine storm is crucial. This study evaluated the clinical experience of TCZ use in the treatment of patients with COVID-19. Methods: This retrospective observational study included patients (>18 years) with confirmed COVID19 treated with TCZ alone/in combination with other drugs. Data related to demographics, clinical characteristics, radiological parameters, oxygen/ventilator/vasopressor support, treatment parameters, laboratory investigations pre- and post-TCZ treatment, and clinical outcomes were retrieved from medical records. Results: Out of 95 patients (mean age, 55 years), 68.4% and 31.6% of patients had moderate and severe COVID-19 disease, respectively. The mean time to TCZ administration from symptom onset was 8.7 days. At the time of admission, the mean oxygen saturation (SpO2) was 90.4% and mean concentration of fraction of inspired oxygen (FiO2) was 80.6%. The most commonly received dose of TCZ was 400 mg (84.2%) intravenously. The mean concentration of FiO2 and SpO2 improved significantly during the treatment (P < 0.001) compared to before TCZ initiation. The change in median levels of C-reactive protein (CRP) from baseline to post-treatment (63.0 vs. 4.5 mg/dL; P < 0.001) was significant. Post TCZ treatment, 73.6% of patients improved; whereas 26.4% of patients died. Acute respiratory distress syndrome (23.2%) and elevated transaminases (12.6%) were the most commonly reported adverse events. Conclusion: Tocilizumab administration during earlier phase of cytokine storm syndrome leads to reversal of abnormal SpO2 and FiO2 concentrations to normal levels and rapid decline of elevated CRP levels in patients with COVID-19.
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Affiliation(s)
- Prince D Surana
- Department of Internal Medicine and Critical Care, Surana Sethia Hospital, Suman Nagar Sion Trombay Road Chembur, Mumbai, India
| | - Rupesh Nayak
- Department of Internal Medicine and Critical Care, Surana Sethia Hospital, Suman Nagar Sion Trombay Road Chembur, Mumbai, India
| | - Arif Sheikh
- Department of Internal Medicine and Critical Care, Surana Sethia Hospital, Suman Nagar Sion Trombay Road Chembur, Mumbai, India
| | - Pradnya Haldankar
- Department of Anesthesia and Critical Care, MPCT Hospital, Sector - 4, Sanpada, Navi Mumbai, Maharashtra, India
| | - Jyoti Kale
- Department of Anesthesia and Critical Care, MPCT Hospital, Sector - 4, Sanpada, Navi Mumbai, Maharashtra, India
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Singh PK, Lalwani LK, Govindagoudar MB, Aggarwal R, Chaudhry D, Kumar P, Gehlaut P. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021; 25:1108-1112. [PMID: 34916741 PMCID: PMC8645820 DOI: 10.5005/jp-journals-10071-23964] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The second wave of COVID-19 pandemic was not only associated with a rapid and severe surge in the number of cases but also limited availability of recommended medicines. Baricitinib has been known to reduce recovery time in COVID-19 pneumonia in association with remdesivir. Tofacitinib, with limited evidence, was used in severe COVID-19 pneumonia based on its similarity of action with baricitinib. Methods Data of all patients admitted to the COVID-19 intensive care unit in the month of April were accessed and analyzed. Data of patients who were on other immunomodulators, invasive ventilation, or suffering from end-stage organ diseases were excluded from the analysis. Results Out of 73 patients, data of 50 were analyzed. Twenty-five received tofacitinib and the other 25 were managed with standard of care. Age, comorbidities, and gender distribution between the two groups were similar. On day 7 of admission, the change in SpO2/FiO2 ratio was 1.26 ± 1 and 0.72 ± 1 in the tofacitinib group and control group, respectively. Similarly, a higher number of subjects in the control group showed worsening in the World Health Organization (WHO) ordinal scale (36 vs 12%, p = 0.01). The clinical objective improvement was similar in the two groups. The intubation rates in the tofacitinib group were significantly lower than that in the control group (32% vs 8%, p = 0.034). Conclusion Tofacitinib, in this retrospective single-center experience, was found to be associated with reduced intubation rates and reduced worsening in the WHO ordinal scale. There was no difference in mortality in the two groups. How to cite this article Singh PK, Lalwani LK, Govindagoudar MB, Aggarwal R, Chaudhry D, Kumar P, et al. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021;25(10):1108-1112.
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Affiliation(s)
- Pawan K Singh
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Lokesh K Lalwani
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | | | - Richa Aggarwal
- Department of Internal Medicine, PGIMS, Rohtak, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Prashant Kumar
- Department of Anesthesiology and Critical Care, PGIMS, Rohtak, Haryana, India
| | - Preeti Gehlaut
- Department of Anesthesiology and Critical Care, PGIMS, Rohtak, Haryana, India
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Sivandzadeh GR, Askari H, Safarpour AR, Ejtehadi F, Raeis-Abdollahi E, Vaez Lari A, Abazari MF, Tarkesh F, Bagheri Lankarani K. COVID-19 infection and liver injury: Clinical features, biomarkers, potential mechanisms, treatment, and management challenges. World J Clin Cases 2021; 9:6178-6200. [PMID: 34434987 PMCID: PMC8362548 DOI: 10.12998/wjcc.v9.i22.6178] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/07/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
It is hypothesized that liver impairment caused by coronavirus disease 2019 (COVID-19) infection might play a central role in severe clinical presentations. Liver injury is closely associated with severe disease and, even with antiviral drugs, have a poor prognosis in COVID-19 patients. In addition to the common hepatobiliary disorders caused by COVID-19, patients with pre-existing liver diseases demand special considerations during the current pandemic. Thus, it is vital that upon clinical presentation, patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure. Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases, particularly in those with pre-existing metabolic liver injury. The purpose of this study was to determine most recent evidence regarding causality, potential risk factors, and challenges, therapeutic options, and management of COVID-19 infection in vulnerable patients with pre-existing liver injury. This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.
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Affiliation(s)
- Gholam Reza Sivandzadeh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Hassan Askari
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
| | - Ehsan Raeis-Abdollahi
- Department of Medical Sciences, Qom Medical Branch, Islamic Azad University, Qom 1417613151, Iran
| | - Armaghan Vaez Lari
- Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz 6135715794, Iran
| | - Mohammad Foad Abazari
- Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran 1417653761, Iran
| | - Firoozeh Tarkesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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Leelayuwatanakul N, Kongpolprom N, Sriprasart T, Phoophiboon V, Thanthitaweewat V, Thawanaphong S, Sirichana W, Chirakalwasan N, Kawkitinarong K, Sittipunt C, Putcharoen O, Paitoonpong L, Suwanpimolkul G, Jantarabenjakul W, Srisawat N, Pachinburavan M. Multimodality treatment in immunocompromised patients with severe COVID-19: the role of IL-6 inhibitor, intravenous immunoglobulin, and haemoperfusion. Respirol Case Rep 2021; 9:e0733. [PMID: 33732466 PMCID: PMC7938208 DOI: 10.1002/rcr2.733] [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: 12/17/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023] Open
Abstract
Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID-19). Multiple anti-inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life-threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID-19-related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID-19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.
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Affiliation(s)
- Nophol Leelayuwatanakul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Napplika Kongpolprom
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Thitiwat Sriprasart
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Vorakamol Phoophiboon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Vorawut Thanthitaweewat
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Sarita Thawanaphong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Worawan Sirichana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Kamon Kawkitinarong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Chanchai Sittipunt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Opass Putcharoen
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Leilani Paitoonpong
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Gompol Suwanpimolkul
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Watsamon Jantarabenjakul
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
- Department of Paediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Monvasi Pachinburavan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
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