Nucleic Acid Test Results Research Articles

ANÁLISE COMPARATIVA DE MÉTODOS PARA TRIAGEM DE HCV EM SERVIÇOS DE HEMOTERAPIA

Dentre as hepatites virais, a hepatite C (HCV) constitui um significativo problema de saúde pública, havendo a necessidade de testes de triagem cada vez mais eficazes na detecção do HCV, a fim de aumentar a segurança do sangue doado. Esta pesquisa teve por objetivo comparar a eficácia da triagem para HCV entre as metodologias utilizadas pelo hemocentro, verificando, ainda, a possível ocorrência de redução da janela imunológica após a introdução da metodologia de teste de ácidos nucleicos (NAT). O estudo foi realizado por meio de avaliação retrospectiva de planilhas de registro sorológico de 12.443 doadores de sangue triados no período de julho de 2014 a junho de 2015 para o vírus HCV no Hemocentro Regional de Passo Fundo – Hemopasso. Dos possíveis doadores de sangue avaliados, 45 indivíduos (0,36%) apresentaram anti-HCV CMIA inconclusivo com resultado do NAT indetectável. Apenas 7 (0,05%) dos candidatos à doação de sangue apresentaram anti-HCV reagente pela metodologia CMIA e NAT detectável. Não foi observada qualquer detecção no período de janela imunológica do HCV pelo teste NAT. Não houve nenhum resultado falso-positivo pela metodologia CMIA. Assim, as metodologias CMIA e NAT utilizadas em associação são de extrema importância para o esclarecimento de possíveis falsos resultados, essenciais para a diminuição do risco de contaminações pós-transfusionais.

Novel Deep Learning Technique Used in Management and Discharge of Hospitalized Patients with COVID-19 in China.

PurposeThe low sensitivity and false-negative results of nucleic acid testing greatly affect its performance in diagnosing and discharging patients with coronavirus disease (COVID-19). Chest computed tomography (CT)-based evaluation of pneumonia may indicate a need for isolation. Therefore, this radiologic modality plays an important role in managing patients with suspected COVID-19. Meanwhile, deep learning (DL) technology has been successful in detecting various imaging features of chest CT. This study applied a novel DL technique to standardize the discharge criteria of COVID-19 patients with consecutive negative respiratory pathogen nucleic acid test results at a “square cabin” hospital.Patients and MethodsDL was used to evaluate the chest CT scans of 270 hospitalized COVID-19 patients who had two consecutive negative nucleic acid tests (sampling interval >1 day). The CT scans evaluated were obtained after the patients’ second negative test result. The standard criterion determined by DL for patient discharge was a total volume ratio of lesion to lung <50%.ResultsThe mean number of days between hospitalization and DL was 14.3 (± 2.4). The average intersection over union was 0.7894. Two hundred and thirteen (78.9%) patients exhibited pneumonia, of whom 54.0% (115/213) had mild interstitial fibrosis. Twenty-one, 33, and 4 cases exhibited vascular enlargement, pleural thickening, and mediastinal lymphadenopathy, respectively. Of the latter, 18.8% (40/213) had a total volume ratio of lesions to lung ≥50% according to our severity scale and were monitored continuously in the hospital. Three cases had a positive follow-up nucleic acid test during hospitalization. None of the 230 discharged cases later tested positive or exhibited pneumonia progression.ConclusionThe novel DL enables the accurate management of hospitalized patients with COVID-19 and can help avoid cluster transmission or exacerbation in patients with false-negative acid test.

Seroprevalence of SARS-CoV-2 infections among children visiting a hospital.

ABSTRACTImportanceIn this study, we retrospectively investigated the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies within serum samples from children in Beijing, China. These findings provide preliminary guidance regarding population susceptibility to SARS‐CoV‐2, which will aid in establishing policy toward coronavirus disease 2019 (COVID‐19) prevention and control.ObjectiveTo understand the seropositivity of anti‐SARS‐CoV‐2 IgM/IgG antibodies among children in Beijing, China, evaluate the susceptibility of children in Beijing to SARS‐CoV‐2, and provide prima facie evidence to guide SARS‐CoV‐2 prevention and control.MethodsIgM/IgG antibody kits (colloidal gold) were used to conduct preliminary screening of SARS‐CoV‐2 IgM/IgG antibodies in serum samples of children who presented to Beijing Children’s Hospital, Capital Medical University, having fever or requiring hospitalization, from March 2020 to August 2020. Statistical analysis of anti‐SARS‐CoV‐2 antibody seropositivity was performed according to the children’s general demographic characteristics, timing of admission to hospital, presence of pneumonia, and viral nucleic acid test results.ResultsThe study included 19 797 children with both IgM and IgG antibody results. Twenty‐four children had anti‐SARS‐CoV‐2 IgM‐positive results (positive rate of 1.2‰), twelve children had anti‐SARS‐CoV‐2 IgG‐positive results (positive rate of 0.6‰). Viral nucleic acid test results were negative for the above‐mentioned children with positive antibody findings; during the study, two children exhibited positive viral nucleic acid test results, but their anti‐SARS‐CoV‐2 IgM/IgG antibody results were negative. Anti‐SARS‐CoV‐2 IgM antibody seropositivity was higher in the <1‐year‐old group than in the ≥6‐year‐old group. The rates of anti‐SARS‐CoV‐2 IgM seropositivity was highest in August from March to August; IgG results did not significantly differ over time. The rates of anti‐SARS‐CoV‐2 IgM or IgG seropositivity among children with and without suspected pneumonia did not significantly differ between groups.InterpretationDuring the study period, the rates of anti‐SARS‐CoV‐2 IgM/IgG antibody seropositivity were low among children who presented to Beijing Children’s Hospital, Capital Medical University. The findings suggest that children in Beijing are generally susceptible to SARS‐CoV‐2 infection; COVID‐19 prevention and control measures should be strengthened to prevent disease in children.

The clinical characteristics of coronavirus disease 2019 in mild and ordinary female patients

AIMS: the aim of study was to explore the clinical characteristics of coronavirus disease 2019 in mild and ordinary patients, providing guidance for clinical diagnosis and treatment.&#x0D; MATERIALS AND METHODS: Sixty-four patients with positive results of nucleic acid testing were divided into two groups, called the youth group and the older group, to be compared the differences of clinical characteristics.&#x0D; RESULTS: Sixty-nine cases showed normal or decrease in white blood cell count (WBC). One case decreased in lymphocyte count (LYMPH). Seven cases decreased in lymphocyte proportion (LYMPH%). Seven cases increased in C-reactive protein (CRP). Sixteen cases increased in alanine transaminase (ALT). Nineteen cases increased in aspartate transaminase (AST). One case increased in lactic dehydrogenase (LDH). Six cases decreased in creatine kinase (CK). Three cases increased in globulin (GLOB). Thirty-eight cases decreased in serum creatinine (CRE). Five cases decreased in blood urea nitrogen (BUN). The lung CT scanning results showed no statistic difference between two groups (p 0.05). The level of WBC, NEUT, LDH, BUN, potassium (K+) showed statistic difference between two groups (p ˂ 0.05).&#x0D; CONCLUSIONS: Age was a risk factor in COVID-19. In the course of future diagnosis and treatment, blood test might play an increasingly important role.

Factors Associated with a Positive Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Suspected Cases Presenting with Pneumonia: A Retrospective Cohort Study in a Single Medical Center

Background: Coronavirus disease 2019 (COVID-19) has become a global emerging infectious disease. Objectives: To analyze the initial clinical characteristics of COVID-19 suspected and confirmed patients on admission in order to find out which kinds may be more likely to get positive nucleic acid testing results, and to explore the risk factors associated with all-cause death. Methods: Medical records from 309 highly suspected cases with pneumonia were collected from February 13, 2020, to March 14, 2020, in a COVID-19-designated hospital of Wuhan. The majority of the clinical data were collected on the first day of hospital admission. Results: Of 309 patients with median age 64 years (interquartile ranges [IQR], 53–72 years), 111 patients (35.9%) were confirmed by nucleic acid testing (median age 64 years, IQR: 56–71 years; 48 males). Of those 111 patients, 13 (11.7%) patients died. In multivariate analysis, factors associated with positive testing included fatigue (odds ratios [OR] = 3.14; 95% confidence interval [CI]: 1.88–5.24, p < 0.001), cough (OR = 0.55; 95% CI: 0.32–0.95, p = 0.032), no less than 1 comorbidity (OR = 1.77; 95% CI: 1.06–2.98, p = 0.030), and severe pneumonia (OR = 2.67; 95% CI: 1.20–5.97, p = 0.016). Furthermore, age, dyspnea, noneffective antibiotic treatment, white blood cell, lymphocyte, platelets, and organ dysfunction (e.g., higher lactate dehydrogenase) were significantly associated with all-cause in-hospital death in patients with COVID-19. Conclusion: Patients with severe forms of this disease were more likely to get positive results. Age and organ dysfunction were associated with a greater risk of death.

Anxiety and depression levels in Covid-19 disease and their relation to hypertension

ABSTRACT Objectives: The study aimed to assess the relation of anxiety and depression levels with hypertension in COVID-19 outbreak. The analysis of the association of selected socio-demographic and clinical parameters on the presence and severity of psychological distress was also performed. Methods: The study involved 91 patients applying with a medical history supportive of COVID-19 infection. According to the hospitalization criteria and diagnostic result of SARS-CoV-2 nucleic acid test certainty of the disease, three groups were created. Patients with positive SARS-CoV-2 nucleic acid test results were consisted of 31 hospitalized subjects. To assess the applicant psychological state, a specially developed questionnaire was used, as the presence and severities of the symptoms were assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Results: Statistically, a significantly higher average level of depression and a higher incidence of anxiety were demonstrated among applicants in the Covid-19 pandemic (% 24 and % 44). Also a higher level of anxiety was demonstrated in hospitalized patients compared with the outpatient group. Different from the presence of depression symptoms, the presence of anxiety symptoms was associated independently with hypertension in our study group OR 2.6 (95% CI, 0.99–6.78) P = .04). Conclusions: In the aftermath of COVID-19 outbreak both anxiety and depression are common psychological disorders. Also, different from the symptoms of depression, the symptoms of anxiety are associated independently with hypertension. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety irrespective of hospitalized status in the investigated groups.

Follow-up results of 117 discharged patients with coronavirus disease 2019 in Wuhan Mobile Cabin Hospital

To follow up the cured and discharged patients with coronavirus disease 2019 (COVID-19) from Wuhan Mobile Cabin Hospital and investigate their epidemiological and clinical characteristics as well as 2019 novel coronavirus (2019-nCoV) nucleic acid test results, so as to provide evidence for epidemic prevention and control. The clinical data including epidemiology, clinical symptoms, laboratory and imaging data of 117 patients diagnosed with COVID-19 who were admitted to Wuhan Hongshan Mobile Cabin Hospital from February 6 to March 10, 2020 were collected by telephone follow-up and analyzed, so as to provide evidence for the prevention and treatment of COVID-19. Among the 117 COVID-19 patients who met the discharge criteria, there were 49 males and 68 females with an average age of (49.00±11.88) years old, and the average length of hospital stay was (17±6) days. Among them, 91 patients had no obvious symptoms after discharge, and the proportion of asymptomatic patients was 77.78%. A small number of patients had clinical symptoms such as chest distress, palpation and asthma, etc. after discharge. After discharge, 7 patients had chest distress symptom, 5 cases had sore throat and palpitate symptom, 4 patients still had cough, asthma and chest pain existed in 3 cases for each, and headache, diarrhea, difficulty in breathing existed in 1 case for each. The 2019-nCoV nucleic acid results of 7 discharged patients were positive, with a re-positive rate of about 5.98%. The nucleic acid positive result occurred after 10-19 days in meeting the discharge standard. Most of the patients did not receive chest CT scan after discharge, but 24 cases of the patients received chest CT scan during follow-up showed normal manifestations, and the lesions of 6 patients were all almost absorbed or normal. Some patients with COVID-19 in Wuhan Mobile Cabin Hospital who were re-positive with 2019-nCoV nucleic acid after discharge did not cause further transmission. Moreover, the patients with re-positive nucleic acid results were not significantly correlated with their length of hospital stay and the presence of clinical symptoms after discharge as well as CT findings. It is recommended to detect feces or other specimens in discharged patients, and to strengthen the regular monitoring and follow-up of discharged patients.

Negative results in nucleic acid test of COVID-19 patients: assessment from the perspective of clinical laboratories.

Since December 2019, there had been an outbreak of coronavirus disease 2019 (COVID-19). Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is prevalent around the world, and the number of infected cases has increased rapidly. Viral nucleic acid test of SARS-CoV-2 can provide direct evidence for rapid diagnosis, disease course monitoring, and therapeutic efficacy. However, in practice, false-negative results in nucleic acid test are common, causing missed diagnoses, which are not conducive to the prevention and control of this outbreak. This article analyzes the possible causes and proposed measures to reduce the false-negative rate of nucleic acid test results and more effectively curb the outbreak.

Clinical features, laboratory findings and persistence of virus in 10 children with coronavirus disease 2019 (COVID-19)

BackgroundA pandemic caused by SARS-CoV-2 infection (COVID-19) has rapidly spread across the globe. Although many articles have established the clinical characteristics of adult COVID-19 patients so far, limited data are available for children. The aim of this study was to reveal the clinical features, laboratory findings and nucleic acid test results of ten pediatric cases. MethodsIn this retrospective single-center cohort study, pediatric cases with COVID-19 infection were consecutively enrolled in one hospital in Huangshi, China from January 1 to March 11, 2020. ResultsA total of 10 children with COVID-19 were recruited. Of them, four were the asymptomatic type, one was the mild type, and five were the moderate type (including two subclinical ones). All patients were from family clusters. Only fever, nasal discharge and nasal congestion were observed. Lymphopenia and leukopenia were uncommon in our sample but elevated levels of lactate dehydrogenase (LDH) and alpha-hydroxybutyrate dehydrogenase (α-HBDH) were observed frequently. Of these laboratory test variables, no statistical difference was identified between asymptomatic and symptomatic patients. Abnormalities in radiological data were detected in five patients, and representative findings of chest CT images were patchy shadows and ground-glass opacities. There were two cases whose oropharyngeal nucleic acid tests reversed to positive after one negative result, and two patients whose oropharyngeal swabs tested negative but rectal swabs showed positive. ConclusionsClinical symptoms were mild in children with COVID-19. Increased levels of LDH and α-HBDH were potential clinical biomarkers for pediatric cases. More attention should be paid to the SARS-CoV-2 viral assessment of rectal swabs before patients are discharged.

Coronavirus Disease 2019 with Comorbid Pulmonary Tuberculosis: A Case Report

Introduction: Since December 2019, a new type of pneumonia named coronavirus disease 2019 (COVID-19) has been reported in Wuhan, Hubei province, China. At present, there are no relevant reports on cases of COVID-19 and comorbid pulmonary tuberculosis. We herein report a case of a patient with COVID-19 and comorbid pulmonary tuberculosis. Case Presentation: A 47-year-old female patient with COVID-19 positive pharyngeal swabs. She did not have fever, coughing or breathing difficulties. The patient diagnosed as COVID-19, and pulmonary tuberculosis based on the patient's epidemiological history, routine blood test, imaging findings, and COVID-19 nucleic acid test results. Contact and droplet precautions were implemented. Antiviral treatment, anti-tuberculosis treatment, and liver protection treatment were given. The patient has not complained of discomfort, and her condition is stable. Conclusions: COVID-19 and comorbid tuberculosis is suspected, epidemiological history, clinical presentation, laboratory tests, and imaging examinations must be combined to make a comprehensive diagnosis and prompt quarantine and treatment measures should be implemented.

Clinical characteristics of \u201cre-positive\u201d discharged COVID-19 pneumonia patients in Wuhan, China

To analyze the clinical characteristics of re-positive discharged COVID-19 patients and find distinguishing markers. The demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, illness severities and chest CT scan results of 267 patients were collected from 1st January to 15th February 2020. COVID-19 was diagnosed by RT-PCR. Clinical symptoms and nucleic acid test results were collected during the 14 days post-hospitalization quarantine. 30 out of 267 COVID-19 patients were detected re-positive during the post-hospitalization quarantine. Re-positive patients could not be distinguished by demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, chest CT scan results or subsequent clinical symptoms. However, re-positive rate was found to be correlated to illness severity, according the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity-of-disease classification system, and the confusion, urea, respiratory rate and blood pressure (CURB-65) score. Common clinical characteristics were not able to distinguish re-positive patients. However, severe and critical cases classified high according APACHE II and CURB-65 scores, were more likely to become re-positive after discharge.

Nucleic acid and antibody assay results in Chinese patients with coronavirus disease 2019 (COVID-19)

AimTo evaluate the nucleic acid and antibody test results of patients with Coronavirus Disease 2019 (COVID-19) in China. MethodsAll patients with laboratory-confirmed SARS-CoV-2 infection from Jan to Apr 2020were retrospectively analyzed. Clinical characteristics and laboratory test results were obtained from electronic medical records. Patients were divided into three groups based on antibody production, and compared for laboratory test results. ResultsOf 73 patients aged11–82 years, 12 (16.4%), 28 (38.4%), 25 (34.2%) and 8 (11.0%)were ≤ 30, 31–50, 51–70,and ≥ 71 years old, respectively. Thirty-four (46.6%) patients were male. Most individuals had mild symptoms, and no patient died during treatment. All patients were tested positive for SARS-CoV-2 in sputum and nasopharyngeal samples, and 40 (54.8%) were also tested positive in stool. Nine(12.3%) patients were re-positivefor SARS-CoV-2, as assessed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) after discharge. Sixty-five (89.0%) patients had IgM or IgG antibodies against SARS-CoV-2.Among the four age groups, there was no difference in IgG antibody production (P = 0.664).CD3, CD4, CD8 and CD19 cell counts between the antibody producing and non-producing groups showed no significant differences (all P > 0.05).The antibodies disappeared within two months in four patients. Lymphocyte count, C-reactive protein, IL-6, lactate dehydrogenase, alanine aminotransferase, creatinine and D-Dimer levels were similar in the three groups (all P > 0.05). ConclusionsPatients after recovery from COVID-19 can be tested positive for SARS-CoV-2.Some patients may produce antibodies only for a short time, or even no antibodies at all.

Patients with mild and general COVID-19 should be negative for at least 3 consecutive nucleic acid tests before discharged.

Given the global spread of coronavirus disease (COVID-19), strict discharge standard is of great significance for the prevention and control of the epidemic, thus, the purpose of this study is to formulate more strict and scientific discharge standards. A total of 845 patients with mild and general COVID-19 who were considered to be discharged from hospital were included in this study. The median time from the onset of COVID-19 to the occurrence of two consecutive negative nucleic acid tests of these patients was 21 days. 223 of the 845 patients were tested again after two consecutive negative nucleic acid tests and 17.49% of the patients were positive. Moreover, 82.51% (184 of 223) of these patients experienced negative results from three consecutive nucleic acid tests, the median time from the onset of COVID-19 to the occurrence of three consecutive negative nucleic acid tests was 23 days (range: 3–56 days), and 38 of which were further tested after three consecutive negative nucleic acid tests, while about 5.26% (2 of 38) patients showed positive nucleic acid test results. Thus, we suggested that the patient should be negative for at least 3 consecutive nucleic acid tests before discharge, and the test time should be no earlier than the 23rd day since the onset of the disease.

Chest Computed Tomography and Clinical Follow-Up of Discharged Patients with COVID-19 in Wenzhou City, Zhejiang, China.

Rationale: Many clinical studies have focused on the epidemiological and clinical characteristics of inpatients with coronavirus disease (COVID-19). However, there are few reports about the clinical follow-up of discharged patients.Objectives: To describe the follow-up of patients with COVID-19 in Wenzhou City, Zhejiang, China.Methods: We retrospectively reviewed 4-week follow-ups in patients with COVID-19, including computed tomographic (CT) chest scanning, blood testing, and oropharyngeal-swab testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid. The chest CT scans and blood tests were performed on the last day before discharge and 2 weeks and 4 weeks after discharge. The oropharyngeal-swab tests were performed at both 1 week and 2 weeks after discharge. Fifty-one patients with common COVID-19 were enrolled in the study. All the CT and clinical data were collected between January 23 and March 28, 2020.Results: Compared with the abnormalities found on the the last CT scans before discharge, the abnormalities in the lungs at the first and second follow-ups after discharge had been gradually absorbed. The cases with focal ground-glass opacity were reduced from 17.7% to 9.8% of cases. The cases with multiple ground-glass opacities decreased from 80.4% to 23.5%. The cases with consolidation were reduced from 49.0% to 2.0%. The cases with interlobular septal thickening were reduced from 80.4% to 35.3%. The cases with subpleural lines were reduced from 29.4% to 7.8%. The cases with irregular lines were reduced from 41.2% to 15.7%. The lung lesions of 25.5% patients were shown to be fully absorbed on the first CT scans after discharge, and the rate of lung recovery increased to 64.7% after the second follow-up. Nucleic-acid test results became recurrently positive in 17.6% of discharged patients, of whom only 33.3% complained of clinical symptoms. There were no differences in the characteristics of the last CT scans before discharge between the patients with recurrently positive test results and the patients with negative test results. The lung damage was fully absorbed in 55.6% of discharged patients with recurrence of positive test results for SARS-CoV-2 ribonucleic acid.Conclusions: The lung damage due to COVID-19 could be reversible for patients with common COVID-19. A few cases showed recurring positive results of nucleic-acid tests after discharge.

Nano Magnetic Beads Combined with Polymerase Chain Reaction Detection of 2019-nCoV and Analysis of the Epidemiological and Clinical Characteristics of 2019-nCoV Patients

The 2019 novel coronavirus (2019-nCoV) is extremely infectious and the human population globally is generally susceptible to it. Its spread poses a serious threat to public health. Analyzing the epidemiological and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) can more fully demonstrate its characteristics and evolution, and provide effective scientific strategies for preventing and controlling the epidemic. In this study, nucleic acid detection was performed on 228 suspected COVID-19 cases in Ningbo City from January 2020 to August 2020. The RNA of the virus was extracted by the nano magnetic bead method and was detected by real-time fluorescent quantitative PCR. Patients whose test results were positive were considered as research subjects. Clinical data of the patients were collected through a medical record system and the epidemiology and characteristics of COVID-19 were analyzed. Among the 228 suspected cases, 108 patients had a positive nucleic acid test result. The 108 confirmed patients were selected as research subjects, including 9 patients with mild symptoms, 85 patients with common symptoms, and 14 patients with severe symptoms. The age range of the patients was 17–82 years. Overall, 35 patients (32.40%) had complications. The median incubation period for patients was 7.5 days. Seventy patients (64.81%) had a contact history with a diseased individual. In terms of the clinical symptoms of the patients, the following symptoms were identified: fever in 92, cough in 62, fatigue in 34, sputum expectoration in 32, dry cough in 22, sore throat in 19, diarrhea in 8, headache in 8, shortness of breath in 7, nasal congestion in 5, and muscle ache in 5 cases. The results of chest CT imaging showed that 96 patients (88.89%) exhibited bilateral or unilateral pneumonia lesions of varying degrees, manifested as bilateral or unilateral lung patches, cloudy floccules, patches with an increased density shadow. The CT images of 12 patients (11.11%) showed no obvious abnormalities, while 24 cases (22.22%) had absolute white blood cell count of &lt;4×109/L, while 1 case had one of &gt;10×109/L. The absolute neutrophil count in 10 patients (9.26%) increased (&gt;6.3×109/L). The absolute lymphocyte count in 49 patients (45.37%) decreased (&lt;1.1×109/L). The hemoglobin, hematocrit, and platelet levels of the vast majority of patients were normal, while a few were low or high. Fifty-eight patients (53.70%) had elevated C-reactive protein (&gt;10 mg/L); 14 (12.96%) had elevated D-dimer (&gt;256 μg/L); 14 (12.96%) had high levels of alanine aminotransferase (&gt;40 U/L); 9 (8.33%) had increased aspartate aminotransferase (&gt;40 U/L); while 32 (29.6%) had increased lactate dehydrogenase (&gt;250 U/L). COVID-19 in Ningbo is mainly transmitted in clusters, and elderly patients are more likely to develop severe symptoms. There is no significant difference in clinical characteristics between patients with severe conditions and those with mild and common ones.

Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study.

BackgroundCoronavirus disease 2019 (COVID-19) is a new infectious disease, and acute respiratory syndrome (ARDS) plays an important role in the process of disease aggravation. The detailed clinical course and risk factors of ARDS have not been well described.Material/MethodsWe retrospectively investigated the demographic, clinical, and laboratory data of adult confirmed cases of COVID-19 in Beijing Ditan Hospital from Jan 20 to Feb 29, 2020 and compared the differences between ARDS cases and non-ARDS cases. Univariate and multivariate logistic regression methods were employed to explore the risk factors associated with ARDS.ResultsOf the 130 adult patients enrolled in this study, the median age was 46.5 (34–62) years and 76 (58.5%) were male. ARDS developed in 26 (20.0%) and 1 (0.8%) death occurred. Fever occurred in 114 patients, with a median highest temperature of 38.5 (38–39)°C and median fever duration of 8 (3–11) days. The median time from illness onset to ARDS was 10 (6–13) days, the median time to chest CT improvement was 17 (14–21) days, and median time to negative nucleic acid test result was 27 (17–33) days. Multivariate regression analysis showed increasing odds of ARDS associated with age older than 65 years (OR=4.75, 95% CL1.26–17.89, P=0.021), lymphocyte counts [0.5–1×109/L (OR=8.80, 95% CL 2.22–34.99, P=0.002); <0.5×109/L(OR=36.23, 95% CL 4.63–2083.48, P=0.001)], and temperature peak ≥39.1°C (OR=5.35, 95% CL 1.38–20.76, P=0.015).ConclusionsARDS tended to occur in the second week of the disease course. Potential risk factors for ARDS were older age (>65 years), lymphopenia (≤1.0×109/L), and temperature peak (≥39.1°C). These findings could help clinicians to predict which patients will have a poor prognosis at an early stage.

SARS Coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in Children: A Review on Epidemiology, Clinical Presentation, and Diagnosis

Context: Coronavirus Disease 2019 (COVID-19) pandemic has caused irreparable damage to society. The pediatric population may be asymptomatic but has positive viral nucleic acid test results and plays an important role in spreading the infection in populations. However, there is a substantial information gap on the epidemiology, pathology, and clinical presentations of COVID-19 in pediatric patients. Evidence Acquisition: English research articles published before April 18, 2020, were reviewed to understand the clinical characteristics of SARS coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in children. The WHO (https://www.who. int/) and CDC (Centers for Disease Control and Prevention, https://www.cdc.gov/) websites were also reviewed to find eligible studies, besides articles extracted from PubMed, Scopus, and Google Scholar. Results: In comparison with SARS and MERS, COVID-19 seems to have wider clinical symptoms and routes of transmission. Multisystem inflammatory syndrome is a unique clinical feature of this novel virus. The low prevalence of COVID-19 in children may be due to lower contacts or incomplete identification rather than resistance to the virus. Conclusions: As this virus is novel, we believe that lessons learned from SARS and MERS outbreaks are very valuable in handling the current pandemic. The aim of this paper was to provide the updated summary of clinical manifestation, diagnostic, molecular, and genetic aspects of the novel coronavirus in comparison with SARS and MERS coronaviruses in children.

Value of swab types and collection time on SARS-COV-2 detection using RT-PCR assay

ObjectiveLow viral load from patients infected with SARS-CoV-2 during infection late stage easily lead to false negative nucleic acid testing results, thus having great challenges to the prevention and control of the current pandemic. In present study, we mainly aimed to evaluate specimen types and specimen collection timepoint on the positive detection of 2019 novel coronavirus from patients at infection late stage based on RT-PCR testing. MethodsPaired nasopharyngeal swabs, nasal swabs, oropharyngeal swabs and anal swabs were collected from patients infected with SARS-CoV-2 during infection late stage before washing in the morning and afternoon on the same day. Then virus RNA was extracted and tested for 2019-nCoV identification by RT-PCR within 24 h. ResultsViral load was low at late infection stage. Specimens collected before washing in the morning would increase the detection ratio of 2019-nCoV. Detection ratio of nasopharyngeal swab [65 (95 % CI: 49.51–77.87) vs 42.5(95 % CI: 28.51–57.8)] or nasal swab [57.5 (95 % CI: 42.2–71.49) vs 35 (95 % CI: 22.13–50.49)] is higher not only than oropharyngeal swab[22.5 (95 % CI: 12.32–37.5) vs 7.5 (95 % CI: 2.58–19.86)], but also anal swab[2.5 (95 % CI: 0.44–12.88) vs 5 (95 % CI: 1.38–16.5)]. ConclusionsIn summary, our research discovers that nasopharyngeal or nasal swab collected before washing in the morning might be more suitable for detecting of large-scale specimens from patients infected with low SARS-CoV-2 load during infection late stage. Those results could facilitate other laboratories in collecting appropriate specimens for improving detection of SARS-CoV-2 from patients during infection late stage as well as initially screening.

The value of lymphocyte count in determining the severity of COVID-19 and estimating the time for nucleic acid test results to turn negative.

Peripheral blood lymphocyte count is shown to be decreased in patients with COVID-19 in the early stage of the disease. The degree of lymphocyte count reduction is related to COVID-19 severity and could be used as an indicator to reflect the disease severity. Our aim was to investigate the value of lymphocyte count in determining COVID-19 severity and estimating the time for SARS-CoV-2 nucleic acid test results to turn negative. We retrospectively analyzed clinical data of 201 patients with severe and critical COVID-19. The patients were admitted to the West Campus of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology. The data included age, gender, chronic disease, lymphocyte count, and SARS-CoV-2 nucleic acid test results. The age of patients in critically ill group was higher than in severely ill group (p = 0.019). The lymphocyte count of critically ill patients was lower than of severely ill patients. The cutoff value of lymphocyte count to distinguish between the critically ill and the severely ill was 0.735 × 109/L (p = 0.001). The cutoff value of lymphocyte count for SARS-CoV-2 nucleic acid test results turning negative in severely and critically ill patients with chronic diseases (hypertension, diabetes, and coronary heart disease) was 0.835 × 109/L (p = 0.017). The cutoff value of lymphocyte count for SARS-CoV-2 nucleic acid test results turning negative in severely and critically ill male patients was 0.835 × 109/L (p < 0.0001). Lymphocyte count could be an effective indicator to predict COVID-19 severity. It may also be useful in determining the time for nucleic acid test results to turn negative in COVID-19 patients with underlying chronic diseases or male COVID-19 patients with severe and critical conditions.

Asymptomatic COVID-19 infection in patients with cancer at a cancer-specialized hospital in Wuhan, China - Preliminary results.

Patients with cancer are usually immunosuppressive and susceptible to COVID-19 infection. Asymptomatic COVID-19 cases are infective and cannot be identified by symptom-based screening. There is an urgent need to control virus spread by asymptomatic carriers at cancer centres. We aim to describe the characteristics, screening methods, and outcomes of cancer patients with asymptomatic COVID-19 infection and to further explore anti-tumour treatment for this population. We reviewed patients with cancer who were admitted to Hubei Cancer Hospital in Wuhan from February 1, 2020, to April 4, 2020. We collected demographic data, laboratory findings, treatment information, nucleic acid and serum test results, chest computed tomography (CT) information and survival status of cancer patients diagnosed with asymptomatic COVID-19 infection. A total of 16 cancer patients with asymptomatic COVID-19 infection were confirmed. The most common cancer type was breast cancer. The blood cell counts of most patients were in the normal range. Lymphocytes of 100% of asymptomatic carriers were in the normal range. Thirteen (81.3%) patients were positive for virus-specific IgM antibodies, and three (18.8%) were positive by PCR; only one (6.3%) patient showed novel coronavirus pneumonia features on CT. Three (18.3%) patients died, and the cause of death was considered malignancy caused by delaying anti-tumour treatment. Our study shows that the lymphocytes of 100% of asymptomatic carriers were in the normal range. This result indicates that the host immunity of asymptomatic carriers is not significantly disrupted by COVID-19. Single PCR detection is not sufficient to screen among asymptomatic individuals, and a combination of PCR tests, serological tests and CT is of great importance. Unless the tumour is life-threatening or rapidly progressing, we advise restarting active anti-tumour therapy after PCR tests become negative.