1
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Jiang H, Liu F, Chan TC, Yin J, Huang R, Shen L, Tu S, Kang L, Liu W, Zhao N, Zhang D, Xu W, Li W, Liu S, Huang C. Comparison of clinical characteristics between COVID-19 and H7N9 fatal cases: An observational study. Front Public Health 2022; 10:1047362. [PMID: 36504959 PMCID: PMC9729836 DOI: 10.3389/fpubh.2022.1047362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The outbreak of COVID-19 in 2020 is reminiscent of the H7N9 outbreak in 2013, which poses a huge threat to human health. We aim to compare clinical features and survival factors in fatal cases of COVID-19 and H7N9. Methods Data on confirmed COVID-19 and H7N9 fatal cases identified in mainland China were analyzed to compare demographic characteristics and clinical severity. Survival curves were estimated by the Kaplan-Meier method and compared using log-rank tests and a restricted mean survival time model. A Cox regression model was used to identify survival factors in fatal cases of COVID-19 and H7N9. Results Similar demographic characteristics were observed in fatal cases of COVID-19 and H7N9. The proportion of fatal cases of H7N9 receiving antibiotics, antiviral drugs, and oxygen treatment was higher than that of COVID-19. The potential protective factors for fatal COVID-19 cases were receiving antibiotics (HR: 0.37, 95% CI: 0.22-0.61), oxygen treatment (HR: 0.66, 95% CI: 0.44-0.99), and corticosteroids (HR: 0.46, 95% CI: 0.35-0.62). In contrast, antiviral drugs (HR: 0.21, 95% CI: 0.08-0.56) and corticosteroids (HR: 0.45, 95% CI: 0.29-0.69) were the protective factors for H7N9 fatal cases. Conclusion The proportion of males, those having one or more underlying medical condition, and older age was high in COVID-19 and H7N9 fatal cases. Offering antibiotics, oxygen treatment, and corticosteroids to COVID-19 cases extended the survival time. Continued global surveillance remains an essential component of pandemic preparedness.
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Affiliation(s)
- Hui Jiang
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Fangchao Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Jinfeng Yin
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Ruowen Huang
- Beijing Normal University School of Mathematical Sciences, Beijing, China
| | - Li Shen
- Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengjin Tu
- Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Kang
- Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Liu
- Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Na Zhao
- School of Ecology and Environment, Anhui Normal University, Wuhu, China
| | - Di Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Wangli Xu
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, China
| | - Weimin Li
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China,*Correspondence: Shelan Liu
| | - Chaolin Huang
- Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Chaolin Huang
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2
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Ferrari Júnior E, Leite BHM, Gomes EB, Vieira TM, Sepulveda P, Caldas ED. Fatal cases involving new psychoactive substances and trends in analytical techniques. Front Toxicol 2022; 4:1033733. [PMID: 36387045 PMCID: PMC9640761 DOI: 10.3389/ftox.2022.1033733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022] Open
Abstract
New psychoactive substances (NPS) are an emerging public health issue and deaths are commonly associated with polydrug abuse. Moreover, the number of new substances available is constantly increasing, causing intoxications in low doses, characteristics that impose to toxicology and forensic laboratories to keep routine methods up to date, with high detectability and constantly acquiring new analytical standards. Likewise, NPS metabolites and respective elimination pathways are usually unknown, making it difficult the detection and confirmation of the drug involved in the fatal case in an analytical routine. A literature search was performed on PubMed, Scopus and Web of Science databases for papers related to chromatographic analyses from fatal cases related to NPS use published from 2016 to 2021. A total of 96 papers were retrieved and reviewed in this study. Opioids, synthetic cathinones, phenethylamines/amphetamines and cannabinoids were the NPS classes most found in the fatal cases. In many cases, multiple compounds were detected in the biological samples, including prescription and other illegal drugs. Liquid chromatography-tandem mass spectrometry, an alternative to overcome the gas chromatography-mass spectrometry limitations for some compounds, was the analytical technique most used in the studies, and high resolution mass spectrometry was often applied to NPS metabolite investigation and structural characterization and identification of unknown compounds. Toxicological screening and quantitation methods need to be continuously updated to include new substances that are emerging on the drug market that can be fatal at very low doses.
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Affiliation(s)
- Ettore Ferrari Júnior
- Forensic Analysis Laboratory, Criminalistics Institute, The Civil Police of the Federal District, Brasília, Brazil,Laboratory of Toxicology, Department of Pharmacy, University of Brasília, Campus Darcy Ribeiro, Brasília, Brazil
| | | | - Eliude Barbosa Gomes
- Forensic Analysis Laboratory, Criminalistics Institute, The Civil Police of the Federal District, Brasília, Brazil
| | | | - Pedro Sepulveda
- Department of Pharmacy, University of Brasília, Campus Ceilândia, Brasília, Brazil
| | - Eloisa Dutra Caldas
- Laboratory of Toxicology, Department of Pharmacy, University of Brasília, Campus Darcy Ribeiro, Brasília, Brazil,*Correspondence: Eloisa Dutra Caldas,
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3
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Shang M, Wei J, Zou HD, Zhou QS, Zhang YT, Wang CY. Early Warning Factors of Death in COVID-19 Patients. Curr Med Sci 2021; 41:69-76. [PMID: 33582908 PMCID: PMC7881912 DOI: 10.1007/s11596-021-2320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023]
Abstract
The infectious coronavirus disease 2019 (COVID-19) has spread all over the world and been persistently evolving so far. The number of deaths in the whole world has been rising rapidly. However, the early warning factors for mortality have not been well ascertained. In this retrospective, single-centre cohort study, we included some adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Renmin Hospital of Wuhan University who had been discharged or had died by Apr. 8, 2020. Demographic, clinical and laboratory data at admission were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable analysis, Cox proportional hazard model analysis and receiver operating characteristic (ROC) curve to explore the early warning factors associated with in-hospital death. A total of 159 patients were included in this study, of whom 86 were discharged and 73 died in hospital. Hypertension (52.1% vs. 29.1%, P=0.003) and coronary heart disease (28.8% vs. 12.8%, P=0.012) were more frequent among non-survived patients than among survived patients. The proportions of patients with dyspnoea (67.1% vs. 25.6%, P<0.001), chest distress (58.9% vs. 26.7%, P<0.001) and fatigue (64.4% vs. 25.6%, P<0.001) were significantly higher in the non-survived group than in the survived group. Regression analysis with the Cox proportional hazards mode revealed that increasing odds of in-hospital death were associated with higher IL-6 (odds ratio 10.87, 95% CI 1.41-83.59; P=0.022), lactate (3.59, 1.71-7.54; P=0.001), older age (1.86, 1.03-3.38; P=0.041) and lower lymphopenia (5.44, 2.71-10.93; P<0.001) at admission. The areas under the ROC curve (AUCs) of IL-6, lymphocyte, age and lactate were 0.933, 0.928, 0.786 and 0.753 respectively. The AUC of IL-6 was significantly higher than that of age (z=3.332, P=0.0009) and lactate (z=4.441, P<0.0001) for outcome prediction. There was no significant difference between the AUCs of IL-6 and lymphocyte for outcome prediction (z=0.372, P=0.7101). It was concluded that the potential risk factors of higher IL-6, lactate, older age and lower lymphopenia at admission could help clinicians to identify patients with poor prognosis at an early stage.
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Affiliation(s)
- Min Shang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Jie Wei
- Department of Intensive Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060 China
- Department of Critical Care Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Han-dong Zou
- Department of Intensive Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060 China
- Department of Critical Care Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Qing-shan Zhou
- Department of Intensive Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060 China
- Department of Critical Care Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Yun-ting Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060 China
| | - Chang-yong Wang
- Department of Intensive Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060 China
- Department of Critical Care Medical Centre, Renmin Hospital of Wuhan University, Wuhan, 430060 China
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4
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Nevels M, Zhang Y, Bambrick H, Tong S, Lambert SB, Hu W. Rapid shortening of survival duration in early fatal cases of COVID-19, Wuhan, China. Exp Results 2021; 2:e6. [PMID: 34192227 DOI: 10.1017/exp.2020.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
Severe COVID-19 cases place immediate pressure on hospital resources. To assess this, we analysed survival duration in the first 39 fatal cases in Wuhan, China. Time from onset and hospitalization to death declined rapidly, from ~40 to 7 days, and ~25 to 4 days, respectively, in the outbreak’s first month.
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5
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de Lima STS, de Souza WM, Cavalcante JW, da Silva Candido D, Fumagalli MJ, Carrera JP, Simões Mello LM, De Carvalho Araújo FM, Cavalcante Ramalho IL, de Almeida Barreto FK, de Melo Braga DN, Simião AR, Miranda da Silva MJ, Alves Barbosa Oliveira RDM, Lima CPS, de Sousa Lins C, Barata RR, Pereira Melo MN, Caldas de Souza MP, Franco LM, Fernandes Távora FR, Queiroz Lemos DR, de Alencar CHM, de Jesus R, de Souza Fonseca V, Dutra LH, de Abreu AL, Lima Araújo EL, Ribas Freitas AR, Vianez Júnior JLDSG, Pybus OG, Figueiredo LTM, Faria NR, Nunes MRT, Cavalcanti LPDG, Miyajima F. Fatal Outcome of Chikungunya Virus Infection in Brazil. Clin Infect Dis 2020; 73:e2436-e2443. [PMID: 32766829 PMCID: PMC8492446 DOI: 10.1093/cid/ciaa1038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused approximately 2.1 million cases and >600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological, and viral genomic features associated with deaths caused by CHIKV in Ceará state, northeast Brazil. METHODS Sera, cerebrospinal fluid (CSF), and tissue samples from 100 fatal cases with suspected arbovirus infection were tested for CHIKV, dengue virus (DENV), and Zika virus (ZIKV). Clinical, epidemiological, and death reports were obtained for patients with confirmed CHIKV infection. Logistic regression analysis was undertaken to identify independent factors associated with risk of death during CHIKV infection. Phylogenetic analysis was conducted using whole genomes from a subset of cases. RESULTS Sixty-eight fatal cases had CHIKV infection confirmed by reverse-transcription quantitative polymerase chain reaction (52.9%), viral antigen (41.1%), and/or specific immunoglobulin M (63.2%). Co-detection of CHIKV with DENV was found in 22% of fatal cases, ZIKV in 2.9%, and DENV and ZIKV in 1.5%. A total of 39 CHIKV deaths presented with neurological signs and symptoms, and CHIKV-RNA was found in the CSF of 92.3% of these patients. Fatal outcomes were associated with irreversible multiple organ dysfunction syndrome. Patients with diabetes appear to die at a higher frequency during the subacute phase. Genetic analysis showed circulation of 2 CHIKV East-Central-South African (ECSA) lineages in Ceará and revealed no unique virus genomic mutation associated with fatal outcome. CONCLUSIONS The investigation of the largest cross-sectional cohort of CHIKV deaths to date reveals that CHIKV-ECSA strains can cause death in individuals from both risk and nonrisk groups, including young adults.
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Affiliation(s)
| | | | | | | | | | - Jean-Paul Carrera
- Department of Zoology, University of Oxford, Oxford, United Kingdom.,Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | | | | | | | | | | | | | | | | | | | - Camila de Sousa Lins
- Faculdade de Medicina do Centro Universitário Christus, Fortaleza, Ceará, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Oliver G Pybus
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Nuno Rodrigues Faria
- Department of Zoology, University of Oxford, Oxford, United Kingdom.,Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | | | - Fabio Miyajima
- Federal University of Ceará, Fortaleza, Brazil.,Oswaldo Cruz Foundation (Fiocruz), Branch Ceará, Eusebio, Brazil
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6
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Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, Wang X, Hu C, Ping R, Hu P, Li T, Cao F, Chang C, Hu Q, Jin Y, Xu G. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. Am J Respir Crit Care Med 2020. [PMID: 32242738 DOI: 10.1164/rccm.202003‐0543oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Rationale: The global death toll from coronavirus disease (COVID-19) virus as of May 12, 2020, exceeds 286,000. The risk factors for death were attributed to advanced age and comorbidities but have not been accurately defined.Objectives: To report the clinical features of 85 fatal cases of COVID-19 in two hospitals in Wuhan.Methods: Medical records were collected of 85 fatal cases of COVID-19 between January 9, 2020, and February 15, 2020. Information recorded included medical history, exposure history, comorbidities, symptoms, signs, laboratory findings, computed tomographic scans, and clinical management.Measurements and Main Results: The median age of the patients was 65.8 years, and 72.9% were male. Common symptoms were fever (78 [91.8%]), shortness of breath (50 [58.8%]), fatigue (50 [58.8%]), and dyspnea (60 [70.6%]). Hypertension, diabetes, and coronary heart disease were the most common comorbidities. Notably, 81.2% of patients had very low eosinophil counts on admission. Complications included respiratory failure (80 [94.1%]), shock (69 [81.2%]), acute respiratory distress syndrome (63 [74.1%]), and arrhythmia (51 [60%]), among others. Most patients received antibiotic (77 [90.6%]), antiviral (78 [91.8%]), and glucocorticoid (65 [76.5%]) treatments. A total of 38 (44.7%) and 33 (38.8%) patients received intravenous immunoglobulin and IFN-α2b, respectively.Conclusions: In this depictive study of 85 fatal cases of COVID-19, most cases were males aged over 50 years with noncommunicable chronic diseases. The majority of the patients died of multiple organ failure. Early onset of shortness of breath may be used as an observational symptom for COVID-19 exacerbations. Eosinophilopenia may indicate a poor prognosis. A combination of antimicrobial drugs did not offer considerable benefit to the outcome of this group of patients.
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Affiliation(s)
- Yingzhen Du
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Lei Tu
- Division of Gastroenterology, Wuhan Union Hospital, Tongji Medical College and
| | - Pingjun Zhu
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Mi Mu
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Runsheng Wang
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Pengcheng Yang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.,Wuhan Hannan Hospital, Wuhan, China
| | - Xi Wang
- Department of Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, and
| | - Chao Hu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Rongyu Ping
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Peng Hu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Tianzhi Li
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Feng Cao
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Christopher Chang
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, California; and.,Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Qinyong Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.,Wuhan Hannan Hospital, Wuhan, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, National Health Commission Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Guogang Xu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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7
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Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, Wang X, Hu C, Ping R, Hu P, Li T, Cao F, Chang C, Hu Q, Jin Y, Xu G. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan. A Retrospective Observational Study. Am J Respir Crit Care Med 2020; 201:1372-1379. [PMID: 32242738 PMCID: PMC7258652 DOI: 10.1164/rccm.202003-0543oc] [Citation(s) in RCA: 596] [Impact Index Per Article: 149.0] [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: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
Rationale: The global death toll from coronavirus disease (COVID-19) virus as of May 12, 2020, exceeds 286,000. The risk factors for death were attributed to advanced age and comorbidities but have not been accurately defined.Objectives: To report the clinical features of 85 fatal cases of COVID-19 in two hospitals in Wuhan.Methods: Medical records were collected of 85 fatal cases of COVID-19 between January 9, 2020, and February 15, 2020. Information recorded included medical history, exposure history, comorbidities, symptoms, signs, laboratory findings, computed tomographic scans, and clinical management.Measurements and Main Results: The median age of the patients was 65.8 years, and 72.9% were male. Common symptoms were fever (78 [91.8%]), shortness of breath (50 [58.8%]), fatigue (50 [58.8%]), and dyspnea (60 [70.6%]). Hypertension, diabetes, and coronary heart disease were the most common comorbidities. Notably, 81.2% of patients had very low eosinophil counts on admission. Complications included respiratory failure (80 [94.1%]), shock (69 [81.2%]), acute respiratory distress syndrome (63 [74.1%]), and arrhythmia (51 [60%]), among others. Most patients received antibiotic (77 [90.6%]), antiviral (78 [91.8%]), and glucocorticoid (65 [76.5%]) treatments. A total of 38 (44.7%) and 33 (38.8%) patients received intravenous immunoglobulin and IFN-α2b, respectively.Conclusions: In this depictive study of 85 fatal cases of COVID-19, most cases were males aged over 50 years with noncommunicable chronic diseases. The majority of the patients died of multiple organ failure. Early onset of shortness of breath may be used as an observational symptom for COVID-19 exacerbations. Eosinophilopenia may indicate a poor prognosis. A combination of antimicrobial drugs did not offer considerable benefit to the outcome of this group of patients.
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Affiliation(s)
- Yingzhen Du
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Lei Tu
- Division of Gastroenterology, Wuhan Union Hospital, Tongji Medical College and
| | - Pingjun Zhu
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Mi Mu
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Runsheng Wang
- Department of Respiratory Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Medical School of Chinese People's Liberation Army (PLA)
| | - Pengcheng Yang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
- Wuhan Hannan Hospital, Wuhan, China
| | - Xi Wang
- Department of Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, and
| | - Chao Hu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Rongyu Ping
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Peng Hu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Tianzhi Li
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Feng Cao
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Christopher Chang
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, California; and
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children’s Hospital, Hollywood, Florida
| | - Qinyong Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
- Wuhan Hannan Hospital, Wuhan, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, National Health Commission Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Guogang Xu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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8
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Nunes PCG, Nogueira RMR, Heringer M, Chouin-Carneiro T, Damasceno Dos Santos Rodrigues C, de Filippis AMB, Lima MDRQ, Dos Santos FB. NS1 Antigenemia and Viraemia Load: Potential Markers of Progression to Dengue Fatal Outcome? Viruses 2018; 10:E326. [PMID: 29903980 PMCID: PMC6024368 DOI: 10.3390/v10060326] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 01/03/2018] [Revised: 02/22/2018] [Accepted: 03/01/2018] [Indexed: 01/29/2023] Open
Abstract
Dengue is a worldwide problem characterized by a multifactorial pathogenesis. Considering the viral components, it is known that high viremia or high levels of the secreted nonstructural protein 1 (NS1) may be associated with a more severe disease. We aimed to characterize the NS1 antigenemia and viremia in dengue fatal and non-fatal cases, as potential markers of progression to a fatal outcome. NS1 antigenemia and viremia were determined in Brazilian dengue fatal cases (n = 40) and non-fatal cases (n = 40), representative of the four dengue virus (DENV) serotypes. Overall, the fatal cases presented higher NS1 levels and viremia. Moreover, the fatal cases from secondary infections showed significantly higher NS1 levels than the non-fatal ones. Here, irrespective of the disease outcome, DENV-1 cases presented higher NS1 levels than the other serotypes. However, DENV-2 and DENV-4 fatal cases had higher NS1 antigenemia than the non-fatal cases with the same serotype. The viremia in the fatal cases was higher than in the non-fatal ones, with DENV-3 and DENV-4 presenting higher viral loads. Viral components, such as NS1 and viral RNA, may be factors influencing the disease outcome. However, the host immune status, comorbidities, and access to adequate medical support cannot be ruled out as interfering in the disease outcome.
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Affiliation(s)
- Priscila Conrado Guerra Nunes
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Rita Maria Ribeiro Nogueira
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Manoela Heringer
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Thaís Chouin-Carneiro
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
- Hematozoa Transmittors Mosquitoes Laboratory, Oswaldo Cruz Institute, Rio de Janeiro 21040-360, Brazil.
| | | | - Ana Maria Bispo de Filippis
- Flavivirus Laboratory (LABFLA), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Monique da Rocha Queiroz Lima
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Flávia Barreto Dos Santos
- Viral Immunology Laboratory (LIV), Oswaldo Cruz Institute-FIOCRUZ, Avenida Brasil, 4365. Manguinhos, Rio de Janeiro 21040-360, Brazil.
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Wang Z, Nicholls JM, Liu F, Wang J, Feng Z, Liu D, Sun Y, Zhou C, Li Y, Li H, Qi S, Huang X, Sui J, Liao Q, Peiris M, Yu H, Wang Y. Pulmonary and central nervous system pathology in fatal cases of hand foot and mouth disease caused by enterovirus A71 infection. Pathology 2016; 48:267-74. [PMID: 27020504 DOI: 10.1016/j.pathol.2015.12.450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/28/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
In the past 17 years, neurological disease associated with enterovirus A71 (EV-A71) has increased dramatically in the Asia-Pacific region with a high fatality rate in young infants, often due to pulmonary oedema, however the mechanism of this oedema remains obscure. We analysed the brainstem, heart and lungs of 15 fatal cases of confirmed EV-A71 infection in order to understand the pathophysiological mechanism of death and pulmonary oedema. In keeping with other case studies, the main cause of death was neurogenic pulmonary oedema. In the brainstem, 11 cases showed inflammation and all cases showed parenchymal inflammation with seven cases showing moderate or severe clasmatodendrosis. No viral antigen was detected in sections of the brainstem in any of the cases. All fatal cases showed evidence of pulmonary oedema; however, there was absence of direct pulmonary viral damage or myocarditis-induced damage and EV-A71 viral antigen staining was negative. Though there was no increase in staining for Na/K-ATPase, 11 of the 15 cases showed a marked reduction in aquaporin-4 staining in the lung, and this reduction may contribute to the development of fatal pulmonary oedema.
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Affiliation(s)
- Zijun Wang
- Division of Laboratory Management, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - John M Nicholls
- Department of Pathology, Hong Kong University, Hong Kong Special Administrative Region, China
| | - Fengfeng Liu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Joshua Wang
- Department of Pathology, Hong Kong University, Hong Kong Special Administrative Region, China
| | - Zijian Feng
- Office of the Director, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Dongge Liu
- Pathology Department, Beijing Hospital, Beijing, China
| | - Yanni Sun
- Pathology Department, Beijing Capital Medical University Affiliated Xuanwu Hospital, Beijing, China
| | - Cheng Zhou
- Beijing IPE Center for Clinical Laboratory, Beijing, China
| | - Yunqian Li
- Pathology Department, Affiliated Hospital of Guilin Medical University, China
| | - Hai Li
- Institution for Infectious Disease Control and Prevention, Guangxi Provincial Centre for Disease Control and Prevention, Nanning, Guangxi, China
| | - Shunxiang Qi
- Institution for Infectious Disease Control and Prevention, Hebei Provincial Centre for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Xueyong Huang
- Institution for Infectious Disease Control and Prevention, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Jilin Sui
- Division of Infectious Disease Control and Prevention, Changping District Centre for Disease Control and Prevention, Beijing, China
| | - Qiaohong Liao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Malik Peiris
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yu Wang
- Office of the Director, Chinese Centre for Disease Control and Prevention, Beijing, China.
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10
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de Araujo J, Duré AIL, Negrão R, Ometto T, Thomazelli LM, Durigon EL. Co-circulation in a single biome of the Juquitiba and Araraquara hantavirus detected in human sera in a sub-tropical region of Brazil. J Med Virol 2015; 87:725-32. [PMID: 25678450 DOI: 10.1002/jmv.24118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 11/08/2022]
Abstract
Hantaviruses is an emerging infectious disease. Although HCPS has been reported in several regions of Brazil, more cases of HCPS have recently been reported in Minas Gerais than in any other state. In 2009, we analyzed 27 samples presenting antibodies against hantaviruses. These samples originated from 688 symptomatic patients, as determined based on the Hemorrhagic Fever Protocol. A subsequent SYBR Green-based real-time RT-PCR demonstrated the presence of the virus in 22 of the samples. Among the RT-PCR-positive samples, 17 were analyzed using DNA sequencing; these sequences were compared with others deposited in GenBank and showed similarity with the Araraquara and Juquitiba virus clusters. This work describe the detection of Juquitiba virus, including three fatal cases, in Minas Gerais state, furthermore, showed that it is feasible to characterize the circulating strains using a small fragment of S segment. Finally, the results suggest the co-circulation of Araraquara and Juquitiba virus in a single biome in Minas Gerais state.
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Affiliation(s)
- Jansen de Araujo
- BSL3+ Clinical and Molecular Virology Laboratory, Department of Microbiology, Institute of Biomedical Science, University of São Paulo (USP), São Paulo, Brazil
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11
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Rozental T, Ferreira MS, Gomes R, Costa CM, Barbosa PR, Bezerra IO, Garcia MH, Oliveira E Cruz DM, Galliez R, Oliveira S, Brasil P, Rezende T, De Lemos ER. A cluster of Rickettsia rickettsii infection at an animal shelter in an urban area of Brazil. Epidemiol Infect 2015; 143:2446-50. [PMID: 25483025 DOI: 10.1017/S0950268814003161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rickettsia rickettsii infection is being increasingly recognized as an important cause of fatal acute illness in Brazil, where this tick-borne disease is designated Brazilian spotted fever (BSF). In this study we report five fatal cases of BSF in employees of an animal shelter in an urban area in the municipality of Rio de Janeiro in southeast Brazil after a natural disaster on 11 January 2011. Four of the cases occurred from 27 January to 11 April 2011, while the fifth fatal case was identified in April 2012. Three cases were confirmed by molecular analysis and two by epidemiological linkage. An investigation of BSF was performed in the animal shelter, and blood samples were collected from 115 employees and 117 randomly selected dogs. The presence of high levels (1024-4096) of antibodies against spotted fever group rickettsiae was found in three (2·6%) employees and 114 (97·5%) dogs. These findings emphasize the need to consider BSF as a possible cause of undifferentiated febrile illness, especially dengue and leptospirosis, in patients occupationally exposed to dogs heavily infested by ticks, mainly working at kennels and animal shelters that have inadequate space for the animals housed and frequently providing an environment conducive to exposure to pathogens such as R. rickettsii.
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