Nasopharyngeal Polymerase Chain Reaction Research Articles

Advocacy for neonates: Will respiratory syncytial virus monoclonal antibodies and maternal vaccine be made available in India?

Respiratory syncytial virus (RSV)-related morbidity in children has been widely described. Research has led to the availability of palivizumab for decades in high-income countries. Ongoing research underlines the high priority given to this conundrum. Nirsevimab, a long-acting monoclonal antibody, and a maternal vaccine have been developed and approved for RSV. Neither of these are available in India. Improving the survival of extreme preterm neonates in our country should parallel other strategies to protect them from diseases that affect these high-risk neonates. This case series comprises sick RSV-infected infants from our centre over a single season. Of 187 young infants who presented to the Neonatology Department with features of viral lower respiratory infections, 9 (4.8%) required intensive care. All of them were positive for RSV by nasopharyngeal polymerase chain reaction. A total of 25 (13%) required hospitalisation. Preterm infants presented with apnea or severe respiratory distress. All 9 in the intensive care unit required respiratory support, and 8 needed invasive ventilation. The median duration of hospital stay for these infants was 18 (7–37) days. This report is an appeal to stakeholders towards making these evidence-based prophylactic methods available in India. A preventable problem in high-risk neonates could be reduced. Improving neonatal survival and outcomes calls for our country to be at par with high-income countries for RSV prevention. RSV-related morbidity is an endemic conundrum with a high disease burden. We could take prompt action, akin to efforts taken during the COVID-19 pandemic.

Impact of Vaccines on Mortality in Patients Treated in The Intensive Care Unit Due To COVID-19: A Multicenter Study

Introduction: The importance of vaccines is increasing day by day because the COVID-19 pandemic has been going on for about two years and there is no effective antiviral treatment. The purpose of this study was to compare the impact of vaccination status on the mortality of patients monitored in the intensive care unit with the diagnosis of COVID-19.
 Methods: Three hundred and forty-four patients treated in intensive care due to COVID-19 in three hospitals in Gaziantep were included in the study. Demographic characteristics and pre-COVID-19 vaccination status of all patients were recorded, and the diagnosis of COVID-19 was made with nasopharyngeal polymerase chain reaction (PCR) test and Thorax Computed Tomography (CT).
 Results: Of the patients, 172 (50%) were male, 172 (50%) were female, 152 (44%) were unvaccinated and 192 (55%) were vaccinated. The number of male patients (n=106) (55.2%) in the vaccinated group was significantly higher than female patients (n=86) (44.8%) (p

Acute and post-acute multidisciplinary outcomes of newborns born from mothers with SARS-CoV-2 infection during pregnancy or the perinatal period

Introduction.We performed a single-center, prospective, observational study of newborns born from mothers with microbiologically confirmed SARS-CoV-2 infection in pregnancy or at time of delivery to evaluate acute and mid-term multidisciplinary outcomes.Methods.Infants were offered a multidisciplinary follow-up consisting of nasopharyngeal Polymerase Chain Reaction test at birth and at 48–72 h of life, auxological and ophthalmological assessments, and serologic testing.Results.791 women and their 791 children (52.3% males) were included. Most placentas (94.9%) had abnormal inflammatory findings. 171 (27.3%) and 36 (13.7%) children respectively had pathological TEOAEs in at least one ear and bilaterally, while only four of the 85 children that underwent ABR had pathological findings (4.7%). 64 children underwent fluorescein angiography, which resulted pathological only in 1 case (1.6%). Anti-SARS-CoV-2 IgGs were found in up to 60% of children tested at six months of age. Our findings showed no association between the maternal vaccination status or the presence of maternal symptoms during pregnancy and neonatal outcomes.Conclusions.Our study shows that the large majority of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life have optimal outcomes. Our previous report of abnormal ophthalmologic findings was not confirmed on a larger cohort, while further studies are needed to better characterize audiological outcomes. Further prospective, case-controlled studies are still needed.

Multiplex Polymerase Chain Reaction Assay to Detect Nasopharyngeal Viruses in Immunocompromised Patients With Acute Respiratory Failure

In immunocompromised patients with acute respiratory failure (ARF), the clinical significance of respiratory virus detection in the nasopharynx remains uncertain. Is viral detection in nasopharyngeal swabs associated with causes and outcomes of ARF in immunocompromised patients? This preplanned post hoc analysis of a randomized controlled trial enrolled immunocompromised patients admitted to 32 ICUs for ARF between May 2016 and December 2017. Nasopharyngeal swabs sampled at inclusion were assessed for 23 respiratory pathogens using multiplex polymerase chain reaction (PCR) assay. Causes of ARF were established by managing physicians and were reviewed by three expert investigators masked to the multiplex PCR assay results. Associations between virus detection in nasopharyngeal swabs, causes of ARF, and composite outcome of day 28 mortality, invasive mechanical ventilation (IMV), or both were assessed. Among the 510 sampled patients, the multiplex PCR assay results were positive in 103 patients (20.2%), and a virus was detected in 102 samples: rhinoviruses or enteroviruses in 35.5%, coronaviruses in 10.9%, and flu-like viruses (influenza virus, parainfluenza virus, respiratory syncytial virus, human metapneumovirus) in 52.7%. The cause of ARF varied significantly according to the results of the multiplex PCR assay, especially the proportion of viral pneumonia: 50.0%with flu-like viruses, 14.0%with other viruses, and 3.6%when no virus was detected (P< .001). No difference was found in the composite outcome of day 28 mortality, IMV, or both according to positive assay findings (54.9%vs54.7%; P= .965). In a pre-established subgroup analysis, flu-like virus detection was associated with a higher rate of day 28 mortality, IMV, or both among recipients of allogeneic hematopoietic stem cell transplantation compared with those without detected virus. In immunocompromised patients with ARF, the results of nasopharyngeal multiplex PCR assays are not associated with IMV or mortality. A final diagnosis of viral pneumonia is retained in one-third of patients with positive assay results and in one-half of the patients with a flu-like virus.

Reliability of nasopharyngeal PCR for the detection of otopathogens in children with uncomplicated acute otitis media compared to culture

Otopathogens in acute otitis media (AOM) have implications for care because the likelihood of resolution without antibiotics and optimal antibiotic agent varies by microorganism. We aimed to determine the sensitivity, specificity, positive predictive value, and negative predictive value of nasopharyngeal (NP) qualitative polymerase chain reaction (PCR) for common bacterial otopathogens in children with AOM compared to NP culture. NP flocked swabs collected from enrolled children aged 6 to 35 months with uncomplicated AOM in Denver, CO were tested by culture and multiplex PCR. The sensitivity and negative predictive value of PCR using culture as a reference were high (H. influenzae 93.3%, 98.0%; S. pneumoniae 94.2%, 95.1%; M. catarrhalis 92.3%, 86.4%); whereas the specificity and positive predictive value were lower and varied by organism (54.2%–84.1%, 55.1%–69.2%, respectively). PCR detected 1.5 times more organisms than culture. NP PCR has a high predictive value for excluding otopathogens compared to culture and warrants exploration as a diagnostic tool.

Persistent and fatal severe acute respiratory syndrome coronavirus 2 infection in a patient with severe hypogammaglobulinemia: a case report

BackgroundViruses are constantly changing as a result of mutations, and new viral variants are expected to appear over time. The virus that causes coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, is not excluded from this condition. Patients with some types of immunodeficiency have been reported to experience symptoms that vary from mild to severe, or even death, after being infected with severe acute respiratory syndrome coronavirus 2. We report a case of a woman with severe hypogammaglobulinemia who developed a prolonged and fatal severe acute respiratory syndrome coronavirus 2 infection.Case presentationA 60-year-old mestizo female with a previous history of severe hypogammaglobulinemia manifested by recurrent pulmonary infections and follicular bronchiolitis. She received a monthly treatment of intravenous immunoglobulins and was admitted after report of a neurological manifestation related to a left thalamic inflammatory lesion, for a duration of 2 weeks of hospitalization, indicated for the study of her neurological condition, including brain biopsy. Both on admission and 1 week later, nasopharyngeal polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 were performed and reported negative. In the third week of hospitalization, she developed pulmonary symptoms, and a positive test result for severe acute respiratory syndrome coronavirus 2 was evidenced. On Day 3, the patients’ condition worsened as the infection progressed to respiratory failure and required mechanical ventilation. On Day 8 after the coronavirus disease 2019 diagnosis, the polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 showed persistent detection of the virus. Various bacterial coinfections, including Klebsiella pneumoniae and Enterobacter cloacae, were diagnosed and treated. On Day 35, her pulmonary symptoms worsened, and the results of the severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test remained positive. On Day 36, despite all the respiratory support, the patient died. The severe acute respiratory syndrome coronavirus 2 virus was sequenced at the beginning and 8 days after the onset of the disease, and the strain, without obvious mutations in the gene that encodes spike protein, was identified.ConclusionsThis clinical case showed persistent severe acute respiratory syndrome coronavirus 2 detection after 35 days of infection in a patient with severe hypogammaglobulinemia. The sequencing of the virus showed no mutations on the spike protein at 8 days, indicating that, in this case, the persistence of the viral detection was associated with immunodeficiency instead of changes in the viral components.

Protection from Omicron Infection in Residents of Nursing and Retirement Homes in Ontario, Canada.

To identify factors that contribute to protection from infection with the Omicron variant of SARS-CoV-2 in older adults in nursing and retirement homes. Longitudinal cohort study with retrospective analysis of infection risk. 997 residents of nursing and retirement homes from Ontario, Canada, in the COVID in LTC study. Residents with 3 messenger RNA (mRNA) dose vaccinations were included in the study. SARS-CoV-2 infection was determined by positive nasopharyngeal polymerase chain reaction test and/or circulating antinucleocapsid IgG antibodies. Cumulative probability of Omicron infection after recent COVID-19 was assessed by log-rank test of Kaplan-Meier curves. Cox regression was used to assess risk of Omicron infection by age, sex, mRNA vaccine combination, whether individuals received a fourth dose, as well as recent COVID-19. In total, 171 residents (17.2%) had a presumed Omicron variant SARS-CoV-2 infection between December 15, 2021 (local start of the first Omicron wave) and May 3, 2022. Risk of Omicron infection was not different by age [hazard ratio (95% confidence interval) 1.01 (0.99‒1.02)], or in women compared with men [0.97 (0.70‒1.34)], but infection risk decreased 47% with 3 vaccine doses of mRNA-1273 (Moderna) compared with BNT162b2 (Pfizer) [0.53 (0.31-0.90)], 81% with any fourth mRNA vaccine dose [0.19 (0.12‒0.30)], and 48% with SARS-CoV-2 infection in the 3months prior to beginning of the Omicron wave [0.52, (0.27‒0.99)]. Vaccine type (ie, mRNA-1273/Spikevax vs BNT162b2/Cominarty), any fourth vaccine dose, and hybrid immunity from recent COVID-19, were protective against infection with the Omicron variant. These data emphasize the importance of vaccine type, and number of vaccine doses, in maintenance of protective immunity and reduction of risk of Omicron variant breakthrough infection. These findings promote continued public health efforts to support vaccination programs and monitor vaccine immunogenicity in older adults.

Unexpected Severe Bocavirus Infections among Hospitalized Children during the COVID-19 Pandemic

Abstract Objective Acute respiratory tract infections are one of the leading causes of morbidity and mortality in children. Although human bocavirus (HBoV) infections are not as common as other seasonal respiratory viruses, children who are infected with HBoV are more likely to suffer from a variety of respiratory conditions, including the common cold, acute otitis media, asthma exacerbations, bronchiolitis pneumonia, some of the affected children require pediatric intensive care unit stay. Here, we aimed to evaluate pediatric bocavirus (HBoV) cases presenting with severe respiratory tract symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Methods This retrospective study evaluated the medical records of children diagnosed with respiratory infections, followed up at the Faculty of Medicine, Eskisehir Osmangazi University between September 2021 and March 2022. In this study, patients with HBoV identified using nasopharyngeal polymerase chain reaction (PCR) were considered positive. Cases were analyzed retrospectively for their clinical characteristics. Results This study included 54 children (29 girls and 25 boys) with HBoV in nasopharyngeal PCR samples. The cases ranged in age from 1 month to 72 months (median 25 months). At the time of presentation, cough, fever, and respiratory distress were the most prevalent symptoms. Hyperinflation (48%), pneumonic consolidation (42%), and pneumothorax–pneumomediastinum (7%) were observed on the chest X-ray; 54% of the children required intensive care unit stay. The median length of hospitalization was 6 days. Bacterial coinfection was detected in 7 (17%) children, while HBoV and other viruses were present in 20 (37%) children; 57% of children received supplemental oxygen by mask, 24% high-flow nasal oxygen, 7% continuous positive airway pressure, and 9% invasive mechanical ventilation support. Antibiotics were given to 34 (63%) cases, and systemic steroid treatment was given to 41 (76%) cases. Chest tubes were inserted in three out of the four cases with pneumothorax–pneumomediastinum. All patients were recovered and were discharged from the hospital. Conclusion The COVID-19 pandemic changed the epidemiology of seasonal respiratory viruses and the clinical course of the diseases. Although it usually causes mild symptoms, severe respiratory symptoms can lead to life-threatening illnesses requiring intensive care admission.

Finding positive SARS-CoV-2 RT-PCR in cerebrospinal fluid of two pediatric patients with severe COVID-19: a brief case report

BackgroundThere is growing evidence of nervous system involvement and related complaints in children with coronavirus disease 2019 (COVID-19). However, it seems that attempts to track of the virus in the nervous system have so far been unsuccessful.Case presentationHere we describe two pediatric cases of severe COVID-19 who had positive cerebrospinal fluid (CSF) and nasopharyngeal polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus disease 2019 (SARS-CoV-2). A 36-month-old girl who presented with fever, diarrhea, mild left ventricular dysfunction and bizarre movements, and a five-month-old boy who presented with fever, watery diarrhea, severe dehydration, mottling, and two episodes of seizure. Their CSF analyses and cultures were normal. They admitted in intensive care unit (ICU) for near four days and discharged after ten days without any complaint.ConclusionThis is one of the first reports of the presence of coronavirus in the central nervous system in COVID-19 pediatric patients, emphasizing the neurotropism and neuroinvasion characteristics of the virus.

Breath Analysis of COVID-19 Patients in a Tertiary UK Hospital by Optical Spectrometry: The E-Nose CoVal Study.

Throughout the SARS-CoV-2 pandemic, diagnostic technology played a crucial role in managing outbreaks on a national and global level. One diagnostic modality that has shown promise is breath analysis, due to its non-invasive nature and ability to give a rapid result. In this study, a portable FTIR (Fourier Transform Infra-Red) spectrometer was used to detect chemical components in the breath from Covid positive symptomatic and asymptomatic patients versus a control cohort of Covid negative patients. Eighty-five patients who had a nasopharyngeal polymerase chain reaction (PCR) test for the detection of SARS-CoV-2 within the last 5 days were recruited to the study (36 symptomatic PCR positive, 23 asymptomatic PCR positive and 26 asymptomatic PCR negative). Data analysis indicated significant difference between the groups, with SARS-CoV-2 present on PCR versus the negative PCR control group producing an area under the curve (AUC) of 0.87. Similar results were obtained comparing symptomatic versus control and asymptomatic versus control. The asymptomatic results were higher than the symptomatic (0.88 vs. 0.80 AUC). When analysing individual chemicals, we found ethanol, methanol and acetaldehyde were the most important, with higher concentrations in the COVID-19 group, with symptomatic patients being higher than asymptomatic patients. This study has shown that breath analysis can provide significant results that distinguish patients with or without COVID-19 disease/carriage.

Nasopharyngeal rapid diagnostic testing to reduce unnecessary antibiotic use and individualize management of acute otitis media.

Acute otitis media (AOM) is the most common indication for antibiotics in children. The associated organism can influence the likelihood of antibiotic benefit and optimal treatment. Nasopharyngeal polymerase chain reaction can effectively exclude the presence of organisms in middle-ear fluid. We explored the potential cost-effectiveness and reduction in antibiotics with nasopharyngeal rapid diagnostic testing (RDT) to direct AOM management. We developed 2 algorithms for AOM management based on nasopharyngeal bacterial otopathogens. The algorithms provide recommendations on prescribing strategy (ie, immediate, delayed, or observation) and antimicrobial agent. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life day (QALD) gained. We used a decision-analytic model to evaluate the cost-effectiveness of the RDT algorithms compared to usual care from a societal perspective and the potential reduction in annual antibiotics used. An RDT algorithm that used immediate prescribing, delayed prescribing, and observation based on pathogen (RDT-DP) had an ICER of $1,336.15 per QALD compared with usual care. At an RDT cost of $278.56, the ICER for RDT-DP exceeded the willingness to pay threshold; however, if the RDT cost was <$212.10, the ICER was below the threshold. The use of RDT was estimated to reduced annual antibiotic use, including broad-spectrum antimicrobial use, by 55.7% ($4.7 million for RDT vs $10.5 million for usual care). The use of a nasopharyngeal RDT for AOM could be cost-effective and substantially reduce unnecessary antibiotic use. These iterative algorithms could be modified to guide management of AOM as pathogen epidemiology and resistance evolve.

187. Nasopharyngeal Testing to Individualize Management of Acute Otitis Media

Abstract Background There are &amp;gt; 10 million antibiotics prescribed yearly for acute otitis media (AOM). The associated organism can influence the likelihood of antibiotic benefit and optimal treatment. A rapid diagnostic test (RDT) for AOM could prevent unnecessary antibiotic use, while assuring those likely to benefit from antibiotics receive the appropriate agent. Nasopharyngeal (NP) polymerase chain reaction can effectively exclude the presence of organisms in middle ear fluid and may be useful to individualize care. Objective: To explore the potential cost-effectiveness and reduction in antibiotics with NP RDTs to direct AOM management. Methods We developed two algorithms for AOM management based on NP bacterial otopathogens (Figure1). The algorithms provide recommendations on prescribing strategy (immediate, delayed, or observation) and antimicrobial agent. We utilized a tiering system based on expected pathogen-associated severity and resistance. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality adjusted life day gained (QALD). We used a decision-analytic model to evaluate the cost-effectiveness of the RDT algorithms compared to usual care from a societal perspective over a 30-day time horizon. Secondary outcomes included the (1) cost at which a RDT would be cost-effective and (2) potential reduction in annual antibiotics used. Flow diagram Figure 1:Flow diagram for management of AOM including RDT-DP and RDT-OBS algorithms Results An RDT algorithm that used immediate, delayed prescribing, and observation based on pathogen (RDT-DP) had an ICER of $1336.15/QALD compared with usual care and strongly dominated the RDT that used only immediate prescribing and observation (RDT-OBS). At an RDT cost of $278.56, the ICER for RDT-DP exceeded the willingness to pay threshold ($274 per QALD gained); however, if the cost of the RDT was &amp;lt; $212.10, the ICER was below the threshold. Both algorithms reduced annual antibiotic use, including broad-spectrum use, compared to usual care (RDT-DP 4.7 million (56% reduction), RDT-OBS 5.4 million (49% reduction), usual care 10.5 million). Conclusion The use of a NP RDT for AOM is likely to be cost-effective and substantially reduce unnecessary antibiotic use. These iterative algorithms could be modified to guide AOM management as scientific knowledge evolves. Disclosures All Authors: No reported disclosures.

1084. Comparison of Pediatric SARS-CoV-2 Infections During Spring 2020 and Spring 2021

Abstract Background Data is lacking regarding the clinical manifestations of children with SARS-CoV-2 infection during Spring 2021 and how that clinical presentation compares to children who presented during the early months of the pandemic. We sought to compare the presentation and severity of illness among children with a positive PCR test result for SARS-CoV-2 who presented during the Spring 2020 to those who presented for testing during Spring 2021. Methods We identified all patients &amp;lt; 18 years old who had a positive nasopharyngeal polymerase chain reaction (PCR) result for SARS-CoV-2 from 4/1/2020-6/30/2020 and from 4/1/2021-6/30/2021 through a laboratory-based database at a rural academic tertiary care medical center. Data collected included demographics; underlying medical comorbidities; symptoms at the time of SARS-CoV-2 testing; results of SARS-CoV-2 testing and other tests performed at the same time; treatments administered; imaging studies performed; need for hospitalization; and, for those requiring hospitalization, hospital length of stay, and respiratory support. We excluded patients who were hospitalized for reasons other than COVID-19 infection in our hospitalization statistics. Results We identified 331 children with a positive SARS-CoV-2 PCR result who met our inclusion criteria. Among children presenting during the Spring 2021 time period, upper respiratory tract infection (URI) symptoms were much less common than those presenting in Spring 2020 (2% vs 19%, p&amp;lt; 0.001). Additionally, fever and cough were more common among children presenting in Spring 2021 (34% vs 22%, p=0.01) (Table 1). Hospitalization for COVID-19 care occurred in 4% of children overall: 3% of children during the Spring 2020 era and 5% of children during Spring 2021, P=0.587 (Table 2). Self-reported symptoms among children with a positive SARS-CoV-2 polymerase chain reaction test, Spring 2020 vs. Spring 2021. Association of year, patient, and clinical characteristics with hospital admission for care of COVID-19. Conclusion Our study offers insights into the differences in the clinical presentation and outcomes of pediatric patients infected with SARS-CoV-2 during Spring 2020 and Spring 2021, respectively. We found that children infected during Spring 2021 had fever and cough more often and rhinorrhea and nasal congestion less often than children infected during the Spring 2020. Hospitalization was uncommon and was similar in both time periods. Most children requiring hospital admission had an underlying medical comorbidity. Disclosures Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant.

Presence of SARS-CoV-2 on the conjunctival mucosa in patients hospitalized due to COVID-19: Pathophysiological considerations and therapeutic implications.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide pandemic, due to its great capacity to invade the human body. Previous studies have shown that the primary route of invasion of this virus is the human respiratory tract via the co-expression of ACE2 receptor and TMPRSS2, a serine protease on the cellular surface. Interestingly, this condition is present not only on the respiratory epithelium but on the conjunctival mucosa, as well. Thus, we hypothesized that SARS-CoV-2 is present on the conjunctival mucosa. To prove that SARS-CoV-2 can be detected in the conjunctiva. Previously nasopharyngeal swab-sample based real-time polymerase chain reaction (PCR) positive COVID-19 infected patients were selected at the COVID Care Centers of Semmelweis University, Budapest, Hungary. The study was approved by the ethical committee of Semmelweis University. During their recovery, both nasopharyngeal and conjunctival swab-samples were taken and PCR method was used to detect the presence of SARS-CoV-2 RNA. Appropriate statistical analysis was performed. The study population consisted of 97 patients, 49 females (50.5%) and 48 males (49.5%), with a mean age of 67.2 ± 11.9 years. During recovery, with nasopharyngeal swabs, the PCR test was positive in 55 cases (56.70%), whereas with conjunctival swabs it was positive in 8 cases (8.25%). Both tests were positive in 5 cases (5.15%). In some patients, ocular symptoms were observed as well. The rest of the patients (29 cases) had negative nasopharyngeal PCR tests during recovery. Although only in few cases, the data of the present study provides a proof of concept that SARS-CoV-2 can be present on the conjunctival mucosa even in nasopharyngeal negative patients, a finding, which can have clinical importance. Also, on the basis of these findings one can hypothesize that - in addition to the respiratory tract - the conjunctiva can be an entrance route for SARS-CoV-2 to the human body. Thus, in high-risk conditions, in addition to covering the mouth and nose with mask, the protection of the eyes is also strongly recommended.

ODP167 Bell's Palsy As A Possible Post-Covid-19 Complication In Patient With Type 2 Diabetes

Abstract Background Diabetes is associated with increased risk of post COVID-19 infection complications which has been postulated to be due to uncontrolled carbohydrate, fat metabolism and raised insulin resistance. Bell's palsy (BP) is an idiopathic unilateral facial paralysis that constitutes the most common cause immune response after a viral infection. Clinical Case A 48- years-old male with type 2 diabetes (BMI-35,3 kg/m 2,HbA1C- 7.6%). He was on regular treatment with metformin(daily doses (DD)– 1500 mg)for the last five years. Before 4 months for hospitalization in the patient was positive nasopharyngeal polymerase chain reaction (PCR) test for SARS-CoV-2 and he didn't develop clinical symptoms of COVID-19, that confirmed asymptomatic coronavirus disease. The male had no history of trauma or systemic infection, and presented no skin eruptions compatible with herpes zoster infection. There were asymmetric wrinkling of the forehead inability to raise the right eyebrow, failure to close the right eyelid, and right deviation of the angle of the mouth (right-sided droop), suggesting right seventh cranial nerve palsy of lower motor neuron type. Signs of meningeal irritations were absent. The neurologist confirmed the diagnosis of right unilateral BP. On hospital stay the patient was treated: metformin (DD – 2000 mg), dapagliflozin (DD – 10 mg), and subcutaneous insulin degludec (DD – 22 units); oral prednisolone at 40 mg/day for one week, which was subsequently tapered to 35 mg/day for 7 days and 30 mg/day for the next 7 days, with a total of 2 months of treatment and assigned to 15 sessions of acupuncture treatments during 10 minutes 5 times/week. The result discussion of clinical studies that diabetes was not a poor prognostic indicator if treated with corticosteroids in diabetic BP patients. Facial palsy started improving after 15 days of admission, and throat swab PCR for SARS-CoV-2 came negative during hospitalization. He was discharged on the 23th day of admission. After3 months, the treating team contacted the patient by phone and realized that he was in good condition, and his facial weakness had improved significantly. However, there are still some residual weaknesses. The sixth months therapy resulted in patient's recovery functions of right seventh cranial nerve and compensation of type 2 diabetes was achieved (HbA1C-7. 0%). Conclusion We assume that our patient got BP secondary to post-COVID-19 complication. These findings support the use of corticosteroids and sessions of acupuncture when necessary for treatment of post-COVID-19 neurological complications in subjects with diabetes. We believe that further research should be conducted to clarify the pathogenic association between COVID-19 and BP in patients with type 2 diabetes and improve algorithm of treatment. Presentation: No date and time listed

Comparison Between Pediatric Patients With and Without Close Contact With COVID-19 in a Brazilian City During SARS-CoV-2 Pandemics.

Objective:To analyze clinical differences between a pediatric population with and without confirmed positive close contact for the new coronavirus, to establish the symptoms that define a population currently served in a children’s emergency room for which polymerase chain reaction (PCR) collection for SARS-COV-2 is performed, and thus, make clinical and laboratory screening more reliable and applicable in medical routine.Method:Cross-sectional study that characterized 128 children (0-17 years old) who collected PCR for SARS-COV-2 when seen in an emergency room at a private hospital between March and June 2020. Data were collected from the electronic medical record of the researched hospital.Results:Patients positive for close contact with COVID-19 had more diarrhea (P = .03) and less fever (P = .003) and coughing (P = .03). There was no statistically significant difference between the 2 groups on gender distribution, age, isolation of other etiologic agents, chest x-ray abnormalities, or the need for hospitalization. SARS-Cov-2 PCR showed a higher positivity among patients on the close contact positive group (P < .001).Conclusion:As seen in previous research, positive SARS-CoV-2 tests are not required for the pediatric population to be diagnosed with the new coronavirus. Diarrhea should be included in those related to a high suspicion of potential SARS-CoV-2 infection, prompting nasopharyngeal PCR collection. However, fever and cough are unspecific symptoms for SARS-CoV-2 infection and should not be considered as warning signs for parents and, more importantly, for pediatricians to collect screening examinations.

Differences of clinical and supporting examinations in pediatric patients with suspected and confirmed COVID-19

Since most children's COVID-19 symptoms are asymptomatic, it might be challenging to diagnose severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This study aims to determine the differences in clinical features and supporting examinations of pediatric patients with suspected and confirmed COVID-19. A retrospective study was conducted using medical records from 120 eligible children with suspected COVID-19 from March to May 2022 in Surabaya. Incomplete medical records are excluded from the study. We divided them into two groups each 60 children with negative and positive SARS CoV-2 polymerase chain reaction (PCR) results. The Mann-Whitney U test and Chi-square tet were used for the analysis. Male children are more dominant than females (59.2% and 40.8%). The mean age of the children with negative SARS CoV-2 PCR results was 63.98 ± 59.508 months and the positive was 85.38 ± 69.071 months. There are no significant differences in laboratory examination. Only clinical symptoms of myalgia and bilateral diffuse radiological examinations were found to have a significant different in children with suspected and confirmed COVID-19. In conclusion, multiplying the SARS CoV-2 nasopharyngeal PCR swab test in patients with suspected COVID-19 accompanied by atypical symptoms were recommmended prevent poorer outcomes.

Convalescent Plasma for COVID-19: A Single Center Prospective Experience with Serial Antibody Measurements and Review of the Literature.

Background: High-titer convalescent plasma given early for COVID-19 may decrease progression into a severe infection. Here, we reported a study of serial antibody measurements in patients who received CP at our center and performed a systematic review of randomized trials on CP. Methods: Our center participated in the Mayo Clinic Expanded Access Program for COVID-19 Convalescent Plasma. Patients diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction at our center between April and August 2020 were included in the study if staffing was available for specimen collection. Through a colloidal gold immunochromatography assay, these patients’ IgM and IgG antibody responses were measured at baseline (Day 0) and after transfusion (Day 1, 2, etc.). Donor CP antibody levels were measured as well. Results: 110 serum specimens were obtained from 21 COVID-19 patients, 16 of whom received CP. The median time from developing symptoms to receiving CP was 11 days (range 4–21). In 9 of 14 (64%) cases where both recipient and donor CP antibody levels were tested, donor COVID-19 IgG was lower than that of the recipient. Higher donor antibody levels compared with the recipient (R = 0.71, p < 0.01) and low patient IgG before CP transfusion (p = 0.0108) correlated with increasing patient IgG levels from baseline to Day 1. Among all patients, an increased COVID-19 IgG in the short-term and longitudinally was positively correlated with improved clinical outcomes (ρ = 0.69, p = 0.003 and ρ = 0.58, p < 0.006, respectively). Conclusions: In a real-world setting where donor CP was not screened for the presence of antibodies, CP in donors might have less COVID-19 IgG than in recipients. An increase in patient antibody levels in the short term and longitudinally was associated with improved clinical outcomes.

Comparing pregnancy outcomes between symptomatic and asymptomatic COVID-19 positive unvaccinated women: Multicenter study in Saudi Arabia

IntroductionCOVID-19 infection in pregnancy ranges from asymptomatic infection to severe disease. However, the maternal and pregnancy outcomes are primarily favorable. Acute Respiratory Illness (ARI) score is a Visual Triage Checklist for Acute Respiratory symptoms created by the ministry of health of Saudi Arabia 12 to screen the patient for acute respiratory infection with MERS-CoV. It has been used during the COVID-19 pandemic to identify suspected cases and place patients in isolation precautions if the score is≥ 4. MethodThis study is a cross-sectional study of all pregnant women who tested positive for COVID-19 in four medical centers located in four different cities in Saudi Arabia. The study period was from 1/3/2020 until 31/10/2020. Outcomes investigated were the prevalence of COVID infection in pregnant women at the time of delivery. Rate of asymptomatic disease, different maternal and pregnancy outcomes. Women were divided into symptomatic and asymptomatic groups according to the ARI score. The two groups were compared in maternal, perinatal, and neonatal outcomes. Furthermore, the cohort was divided according to maternal age into two groups: women of advanced maternal age ≥ 35 years and younger. The two groups were compared in maternal, perinatal, and neonatal outcomes ResultsDuring the study period, 9573 women gave birth at KAMCs, and 402 pregnant women were identified as COVID positive. Out of all COVID-positive women, only 394 women gave birth at KAMCs. The screening for COVID infection differed between the centers, but the testing was the same by the Nasopharyngeal polymerase chain reaction (PCR) swab. In Riyadh, screening was based on ARI scoring at the beginning of the pandemic. Then, it became universal. In Jeddah, the screening was based on ARI scoring. Any woman who scored four or more was labeled as suspected, and she was tested. Finally, in Madinah and Dammam, the screening was universal throughout the study.The prevalence of COVID-19 infection among women who gave birth at KAMCs was 4.2% (402/9573). (CI 3.8–4.6%). At the time of diagnosis, most women (62%) were asymptomatic. The most common symptoms were cough and shortness of breath. Twenty-two women (5.5%) had Pneumonia, and five women (1.3%) needed admission to Intensive care units (ICU). One woman died due to respiratory failure.When pregnancy outcomes were compared between symptomatic and asymptomatic women, pregnancy in symptomatic women was more likely to be complicated by Abortion (6 versus 2% p-value 0.00), fetal death (3 versus 1.3%), and cesarean delivery (30.8 versus 22.4%, p-value 0.001). COVID-positive pregnant women of advanced maternal age (AMA) were more likely to be symptomatic, have Abortion (5 versus 1%, p-value 0.01), and have Preterm delivery (17 versus 11% p-value 0.01) than younger women. In addition, neonatal death was more common in AMA COVID-positive women than younger (4 versus 0%), regardless of COVID-related symptoms. ConclusionMost of the COVID-infected pregnant women are asymptomatic. Therefore, the ARI scoring system does not help to triage patients. Symptomatic women, especially those older than 35, tend to have a higher maternal and pregnancy complication rate.

C86 TAKO–TSUBO SYNDROME IN PATIENTS WITH COVID–19: A SINGLE CENTRE RETROSPECTIVE CASE SERIES

BackgroundCOVID–19 presents with a wide range of symptoms, from mild flu–like complaints to severe acute respiratory distress and cardiovascular complications. Recent literature provides some case reports of Tako–Tsubo syndrome (TTS) in COVID–19 patients. However, its prevalence, pathophysiological mechanisms and prognostic impact in this setting is unknown.MethodsWe collected data of patients hospitalized for COVID–19 in our multidisciplinary COVID–19 department who had a diagnosis of TTS during hospitalization. The criteria for hospital admission were: 1) naso–pharyngeal polymerase chain reaction diagnosis of SARS–CoV–2 infection and 2) symptoms and signs of mild–moderate COVID–19 with a paO2/FIO2 ratio > 200. The period of the study covered the second and third wave of the pandemic in Italy.ResultsOf 635 patients admitted to our centre, we had four cases, two males and two females, with TTS associated with COVID–19. No patient had any classical trigger for TTS except for COVID–19. Mean age was 72 years (67–81) and all patients had a diagnosis of SARS–CoV–2–related interstitial pneumonia confirmed by computed tomography. One patient was admitted to our centre after stabilization of a critical respiratory distress syndrome that required intubation. All patients showed typical apical ballooning with a transitory reduction of left ventricle (LV) systolic function. The mean LV ejection fraction (LVEF) at TTS onset was 42% (40–48%). ECG showed ST–segment elevation in two cases, while an evolution with negative T waves and long QTc was observed in all patients. All patients were treated in the intensive care unit (ICU), with a median ICU stay of 9 days. The long ICU stay duration was due to intercurrent superinfections. All patients recovered a normal LVEF before discharge. The mean value of the high–sensitivity troponin T peak was 1092 ng/L. Three patients underwent coronary angiography. One patient needed vasopressors in the acute phase. Two patients had a previous diagnosis of cognitive impairment. The time interval from hospital admission to TTS onset was 4 (2–6) days, and the time interval from COVID–19 symptom onset to TTS diagnosis was 10 (8–12) days. The mean hospital stay was 32 days (26–37).ConclusionCOVID–19 may be a trigger for TTS. Possible mechanisms to explain the contribution of COVID–19 to TTS development include the activation of the inflammatory cascade, direct myocardial injury, and stress–related conditions due to COVID–19.