Abstract
PurposeThe current global pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to the investigation with clinical, biochemical, immunological, and genomic characterization from patients to understand the pathophysiology of viral infection.MethodsSamples were collected from six asymptomatic and six symptomatic SARS-CoV-2-confirmed hospitalized patients in Bhubaneswar, Odisha, India. Clinical details, biochemical parameters, and treatment regimen were collected from a hospital; viral load was determined by RT-PCR; and the levels of cytokines and circulating antibodies in plasma were assessed by Bio-Plex and isotyping, respectively. In addition, whole-genome sequencing of viral strains and mutational analysis were carried out.ResultsAnalysis of the biochemical parameters highlighted the increased levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), serum SGPT, serum SGOT, and ferritin in symptomatic patients. Symptomatic patients were mostly with one or more comorbidities, especially type 2 diabetes (66.6%). The virological estimation revealed that there was no significant difference in viral load of oropharyngeal (OP) samples between the two groups. On the other hand, viral load was higher in plasma and serum samples of symptomatic patients, and they develop sufficient amounts of antibodies (IgG, IgM, and IgA). The levels of seven cytokines (IL-6, IL-1α, IP-10, IL-8, IL-10, IFN-α2, IL-15) were found to be highly elevated in symptomatic patients, while three cytokines (soluble CD40L, GRO, and MDC) were remarkably higher in asymptomatic patients. The whole-genome sequence analysis revealed that the current isolates were clustered with 19B, 20A, and 20B clades; however, 11 additional changes in Orf1ab, spike, Orf3a, Orf8, and nucleocapsid proteins were acquired. The D614G mutation in spike protein is linked with higher virus replication efficiency and severe SARS-CoV-2 infection as three patients had higher viral load, and among them, two patients with this mutation passed away.ConclusionsThis is the first comprehensive study of SARS-CoV-2 patients from India. This will contribute to a better understanding of the pathophysiology of SARS-CoV-2 infection and thereby advance the implementation of effective disease control strategies.
Highlights
Coronavirus disease 2019 (COVID-19), which was initially reported to cause pneumonia and flu-like illness in the city of Wuhan, China, has become considerably more perilous, with global efforts undergoing to combat the deadly disease (Yang et al, 2020)
They were detected with a higher percentage of serum serum glutamic pyruvic transaminase (SGPT) (>2-fold) and serum serum glutamic-oxaloacetic transaminase (SGOT) (>2-fold), and almost 83% of the SARSCoV-2 patients were detected with a higher level of ferritin than the normal range (Tables 1 and 2)
Three symptomatic patients who died of SARS-CoV-2 had a significantly higher amount of plasma viremia or viral load, compared with those who were discharged from the hospital
Summary
Coronavirus disease 2019 (COVID-19), which was initially reported to cause pneumonia and flu-like illness in the city of Wuhan, China, has become considerably more perilous, with global efforts undergoing to combat the deadly disease (Yang et al, 2020). According to the WHO, 223 countries to date have been affected by the second wave of COVID-19, with 159,319,384 confirmed cases and an increase in the number of deaths around the world. The vaccination program in India is at its height, the total number of vaccinations given is 1,77,214,256. The second wave of COVID-19 cases surpassed the 23,340,938 mark and death toll continues to rise beyond 258,317 deaths. As of May 13, 2021, Odisha has 100,313 active cases with 2,304 deaths and 64.5 lakhs vaccinated (Ministry of Health and Human Welfare, GOI)
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