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Wong RCW, Lee MKP, Siu GKH, Lee LK, Leung JSL, Leung ECM, Ho YII, Lai RWM. Healthcare workers acquired COVID-19 disease from patients? An investigation by phylogenomics. J Hosp Infect 2021; 115:59-63. [PMID: 34098050 PMCID: PMC8289439 DOI: 10.1016/j.jhin.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022]
Abstract
The increasing number of coronavirus disease 2019 (COVID-19) cases in the community has posed a significant epidemic pressure on healthcare settings. When healthcare workers (HCWs) acquire COVID-19, contact tracing and epidemiological investigation might not be adequate for determining the source of transmission. Here, we report a phylogenetic investigation involving two infected HCWs and nine patients to determine whether patient-to-HCW transmission had occurred in a hospital without a previous COVID-19 outbreak. This is the first study to apply phylogenomics to investigate suspected nosocomial transmission in a region with low prevalence of COVID-19. Our results do not support the occurrence of direct patient-to-HCW transmission.
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Affiliation(s)
- R C W Wong
- Department of Microbiology, Prince of Wales Hospital, Hong Kong SAR, China.
| | - M K P Lee
- Department of Microbiology, Prince of Wales Hospital, Hong Kong SAR, China
| | - G K H Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - L K Lee
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - J S L Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - E C M Leung
- Department of Microbiology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Y I I Ho
- Department of Microbiology, Prince of Wales Hospital, Hong Kong SAR, China
| | - R W M Lai
- Department of Microbiology, Prince of Wales Hospital, Hong Kong SAR, China
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Lee N, Choi KW, Chan PKS, Hui DSC, Lui GCY, Wong BCK, Wong RYK, Sin WY, Hui WM, Ngai KLK, Cockram CS, Lai RWM, Sung JJY. Outcomes of adults hospitalised with severe influenza. Thorax 2010; 65:510-5. [PMID: 20522848 DOI: 10.1136/thx.2009.130799] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of this study was to investigate factors affecting clinical outcomes of adults hospitalised with severe seasonal influenza. METHODS A prospective, observational cohort study was conducted over 24 months (2007-2008) in two acute, general hospitals. Consecutive, hospitalised adult patients were recruited and followed once their laboratory diagnosis of influenza A/B was established (based on viral antigen detection and virus isolation from nasopharyngeal aspirates collected per protocol). Outcomes studied included in-hospital death, length of stay and duration of oxygen therapy. Factors affecting outcomes were analysed using multivariate Cox proportional hazards models. Sequencing analysis on the neuraminidase gene was performed for available H1N1 isolates. RESULTS 754 patients were studied (influenza A, n=539; >75% H3N2). Their mean age was 70+/-18 years; co-morbidities and serious complications were common (61-77%). Supplemental oxygen and ventilatory support was required in 401 (53.2%) and 41 (5.4%) patients, respectively. 39 (5.2%) patients died; pneumonia, respiratory failure and sepsis were the causes. 395 (52%) patients received antiviral (oseltamivir) treatment. Omission of antiviral treatment was associated with delayed presentation or negative antigen detection results. The mortality rate was 4.56 and 7.42 per 1000 patient-days in the treated and untreated patients, respectively; among those with co-morbidities, it was 5.62 and 11.64 per 1000 patient-days, respectively. In multivariate analysis, antiviral use was associated with reduced risk of death (adjusted HR (aHR) 0.27 (95% CI 0.13 to 0.55); p<0.001). Improved survival was observed with treatment started within 4 days from onset. Earlier hospital discharge (aHR 1.28 (95% CI 1.04 to 1.57); p=0.019) and faster discontinuation of oxygen therapy (aHR 1.30 (95% CI 1.01 to 1.69); p=0.043) was associated with early treatment within 2 days. Few (n=15) H1N1 isolates in this cohort had the H275Y mutation. CONCLUSIONS Antiviral treatment for severe influenza is associated with reduced mortality and improved clinical outcomes.
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Affiliation(s)
- N Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Peiris JSM, Chu CM, Cheng VCC, Chan KS, Hung IFN, Poon LLM, Law KI, Tang BSF, Hon TYW, Chan CS, Chan KH, Ng JSC, Zheng BJ, Ng WL, Lai RWM, Guan Y, Yuen KY. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003; 361:1767-72. [PMID: 12781535 PMCID: PMC7112410 DOI: 10.1016/s0140-6736(03)13412-5] [Citation(s) in RCA: 1750] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). METHODS We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. FINDINGS Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. INTERPRETATION The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.
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Affiliation(s)
- JSM Peiris
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - CM Chu
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - VCC Cheng
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - KS Chan
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - IFN Hung
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - LLM Poon
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - KI Law
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - BSF Tang
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - TYW Hon
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - CS Chan
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - KH Chan
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - JSC Ng
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - BJ Zheng
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - WL Ng
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - RWM Lai
- Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital, Hong Kong
| | - Y Guan
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - KY Yuen
- Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Region, China
- Correspondence to: Prof K Y Yuen, Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Special Administrative Region, China
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Chu CM, Lai RWM. Malassezia furfur fungaemia in a ventilator-dependent patient without known risk factors. Hong Kong Med J 2002; 8:212-4. [PMID: 12055369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Malassezia furfur is the lipophilic yeast which causes tinea versicolor and is an uncommon cause of fungaemia. It usually occurs in the context of hyperalimentation with lipid emulsion, immunosuppression, or the presence of a central venous catheter. We report a case of a ventilator-dependent patient who developed Malassezia furfur fungaemia in the absence of these known risk factors. A likely risk factor in this patient was receipt of multiple courses of broad-spectrum antibiotics. This case highlights the importance of recognising Malassezia furfur as a cause of fungaemia, as well as the need for special culture techniques to aid identification.
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Affiliation(s)
- C M Chu
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kowloon, Hong Kong
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