Association between clinical characteristics and CT findings in patients with coronavirus disease-2019

This retrospective study was to investigate the association between clinical characteristics and computerized tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19). The clinical data of COVID-19 patients were retrospectively analyzed. Spearman correlation analysis was used to identify the correlation. Totally 209 consecutive COVID-19 patients were eligible for the study, with the mean age of 47.53 ± 13.52 years. At onset of the disease, the most common symptoms were fever (85.65%) and cough (61.24%). The CT features of COVID-19 included pulmonary, bronchial, and pleural changes, with the significant pulmonary presentation of ground-glass opacification (93.30%), consolidation (48.80%), ground-glass opacification plus a reticular pattern (54.07%), telangiectasia (84.21%), and pulmonary fibrotic streaks (49.76%). Spearman analysis showed that the CT findings had significantly inverse associations with the platelets, lymphocyte counts, and sodium levels, but were positively related to the age, erythrocyte sedimentation rate, D-dimer, lactic dehydrogenase, α-hydroxybutyrate dehydrogenase, and C-reactive protein levels (P < .05). In conclusion, the severity of lung abnormalities on CT in COVID-19 patients is inversely associated with the platelets, lymphocyte count, and sodium levels, whereas positively with the age, erythrocyte sedimentation rate, D-dimer, lactic dehydrogenase, hydroxybutyrate dehydrogenase, and C-reactive protein levels.     

Hospital‐based influenza morbidity and mortality surveillance system for influenza‐like illnesses: a comparison with national influenza surveillance systems

The Hospital‐based Influenza Morbidity and Mortality (HIMM) surveillance system is an emergency room (ER)‐based influenza surveillance system in Korea that was established in 2011. The system was established under the assumption that integrated clinical and virologic surveillance could be performed rapidly and easily at seven tertiary hospitals' ER. Here, we assessed the correlation between data generated from the HIMM surveillance system and the Korean national influenza surveillance systems during the 2011–2012 influenza season using cross‐correlation analysis and found strong correlations. Rapid antigen‐test‐based HIMM surveillance would predict the start of influenza epidemic earlier than pre‐existing influenza‐like‐illness‐based surveillance.     

Epidemiological and clinical characteristics of 70 cases of coronavirus disease and concomitant hepatitis B virus infection: A multicentre descriptive study

The interaction between existing chronic liver diseases caused by hepatitis B virus (HBV) infection and COVID‐19 has not been studied. We analysed 70 COVID‐19 cases combined with HBV infection (CHI) to determine the epidemiological, clinical characteristics, treatment and outcome. We investigated clinical presentation, imaging and laboratory parameters of COVID‐19 patients of seven hospitals from Jan 20 to March 20, 2020. Multivariate analysis was used to analyse risk factors for progression of patients with COVID‐19 combined with HBV infection. Compared with COVID‐19 without HBV infection (WHI) group, patients with dual infection had a higher proportion of severe/critically ill disease (32.86% vs. 15.27%, P = .000), higher levels of alanine aminotransferase (ALT), aspartate transaminase (AST) and activated partial thromboplastin (APTT) [50(28‐69)vs 21(14‐30), P = .000; 40(25‐54) vs 23(18‐30), P = .000; 34.0(27.2‐38.7) vs 37.2(31.1‐41.4), P = .031]. The utilization rates of Arbidol and immunoglobulin were significantly higher than those in the co‐infected group [48.57% vs. 35.64%, P < .05; 21.43% vs. 8.18%, P < .001], while the utilization rate of chloroquine phosphate was lower (1.43% vs 14.00%, P < .05) in the co‐infected patients group. Age and c‐reactive protein (CRP) level were independent risk factors for recovery of patients with COVID‐19 combined with HBV infection. The original characteristics of COVID‐19 cases combined with HBV infection were higher rate of liver injury, coagulation disorders, severe/critical tendency and increased susceptibility. The elderly and patients with higher level of CRP were more likely to experience a severe outcome of COVID‐19.     

Sentinel surveillance of influenza in Burkina Faso: identification of circulating strains during 2010–2012

Background

Although influenza surveillance has recently been improved in some sub-Saharan African countries, no information is yet available from Burkina Faso.

Objectives

Our study was the first to determine the prevalence of influenza viruses circulating in Burkina Faso through a sentinel surveillance system.

Methods

We conducted sentinel surveillance with oropharyngeal (OP) swabs collected from outpatients (1 month to 83 years) from six sites in Bobo-Dioulasso and Ouagadougou, among patients meeting the WHO/CDC case definition for influenza-like illness (ILI; fever ≥38°C, and cough and/or sore throat in the absence of other diagnosis) from July 2010 to May 2012. Influenza viruses were detected by real-time RT-PCR using CDC primers, probes, and protocols.

Results

The first three ILI cases were enrolled each day; of 881 outpatients with ILI enrolled and sampled, 58 (6·6%) tested positive for influenza viruses (29 influenza A and 29 influenza B). Among the influenza A viruses, 55·2% (16/29) were influenza A (H1N1)pdm09 and 44·8% (13/29) were seasonal A (H3N2). No cases of seasonal A/H1N1 were detected. Patients within 0–5 years and 6–14 years were the most affected, comprising 41·4% and 22·4% laboratory-confirmed influenza cases, respectively. Influenza infections occurred during both the dry, dusty Harmattan months from November to March and the rainy season from June to October with peaks in January and August.

Conclusions

This surveillance was the first confirming the circulation of influenza A (H1N1)pdm09, A/H3N2, and influenza B viruses in humans in Burkina Faso.     

Factors associated with transmission of influenza‐like illness in a cohort of households containing multiple children

Background

Household studies of influenza-like illness (ILI) afford opportunities to study determinants of respiratory virus transmission.

Objectives

We examined predictors of ILI transmission within households containing at least two children.

Methods

A prospective cohort study recorded ILI symptoms daily for 2712 adult and child participants during the 1998 influenza season in Victoria, Australia. Logistic and Poisson regressions were used to explore predictors of household transmission of ILI and the secondary household attack proportion (SHAP). A date of illness onset during the influenza season was used as a proxy indicator of ILI associated with influenza infection (as opposed to other aetiological causes).

Results

A total of 1009 ILI episodes were reported by 781 of 2712 (29%) participants residing in 157 households. Transmission, defined as detection of ILI in one or more household members following identification of an index case, was observed in 206 of 705 (29%) household introductions. Transmission of ILI was significantly associated with the onset of ILI in the index case during the peak influenza season compared with the remainder of the observation period (37% versus 27%, odds ratio = 1·59, 95% CI 1·09, 2·31, P = 0·017). The SHAP was 0·12, higher if the index case was of secondary school age [incidence risk ratio (IRR) = 1·80, 95% CI 1·08, 2·98, P = 0·022].

Conclusions

Risk of household transmission of ILI was increased during the peak influenza season, indicating an increased burden of disease during the period of influenza circulation. In this cohort, secondary-school-aged children and adults were important transmitters of ILI.     

对比分析18例重症/危重症新型冠状病毒肺炎心肌损伤患者临床特征

目的回顾性分析伴心肌损伤的重症/危重症新型冠状病毒肺炎(COVID-19)患者临床特征及心肌酶学指标动态变化。方法纳入2020年1月17至3月1日中山大学附属第五医院收治的18例重症/危重症COVID-19患者。依据住院期间心肌酶或肌钙蛋白I检测值,正常范围患者归为非心肌损伤组(n=13),异常升高患者归为心肌损伤组(n=5)。对比分析两组患者入院后的流行病学和临床资料,并分析血常规、肝肾功能、心肌酶、C反应蛋白(CRP)等实验室指标,动态分析肌酸激酶、肌酸激酶同工酶MB、N端脑钠肽前体(NT-proBNP)和肌钙蛋白I变化情况。结果18例重症/危重症患者中,心肌损伤患者占27.8%(5/18)。与非心肌损伤组患者比较,心肌损伤组患者年龄、性别、基础疾病、症状和体征、发病至住院时间、体温、心率、舒张压、住院时间无明显差异,但心肌损伤组患者入院时收缩压明显高于非心肌损伤组(P=0.0171)。两组患者入院时白细胞计数、淋巴细胞计数、单核细胞计数无明显差异;入院时谷丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶、α-羟丁酸脱氢酶、肌酸激酶、肌酸激酶同工酶MB、血肌酐、CRP、N端脑钠肽前体两组患者中也未见明显差异。动态分析发现心肌损伤组重症患者在住院第4~5天左右,肌酸激酶、肌酸激酶同工酶、肌钙蛋白I、N端脑钠肽前体逐渐出现升高,在第9~11天后逐渐恢复正常。结论重症/危重症COVID-19患者收缩压较高可能与容易出现心肌损伤相关,心肌酶谱异常出现在住院的早期,早期发现和干预治疗对心肌损伤患者有益。     

伴或不伴血管钙化的新型冠状病毒肺炎危重症患者临床特征及转归的回顾性分析

目的分析伴或不伴血管钙化的新型冠状病毒肺炎(COVID-19)危重症患者临床特征及转归的差异。方法对2020年2月入住华中科技大学同济医学院附属同济医院重症监护室的COVID-19危重症患者进行回顾性分析。根据胸部CT表现,将患者分为血管钙化组和非血管钙化组,其中血管钙化组又分为主动脉钙化组、冠状动脉钙化组和同时钙化组(主动脉、冠状动脉均有钙化)。比较不同组别患者的临床特征及转归。结果与非血管钙化组相比,血管钙化组患者年龄偏大,合并高血压与冠心病比例更高,表现为更高的白细胞计数、中性粒细胞计数、C反应蛋白、球蛋白、乳酸脱氢酶、国际标准化比值、D-二聚体、肌酐、肌酸激酶同工酶、高敏肌钙蛋白、肌红蛋白、N末端B型脑钠肽原,较低的淋巴细胞计数、血小板计数、白蛋白、估算的肾小球滤过率,且死亡风险更高。与主动脉钙化组比较,冠状动脉钙化组和同时钙化组的转归更差。结论血管钙化特别是冠状动脉钙化可能是COVID-19危重症患者预后不良的危险因素。     

Results of a pilot study using self‐collected mid‐turbinate nasal swabs for detection of influenza virus infection among pregnant women

Background

We evaluated the feasibility of asking pregnant women to self-collect and ship respiratory specimens.

Methods

In a preliminary laboratory study, we compared the RT-PCR cycle threshold (CT) values of influenza A and B viruses incubated at 4 storage temperatures (from 4 to 35°C) for 6 time periods (8, 24, 48, 72, and 168 hours and 30 days), resulting in 24 conditions that were compared to an aliquot tested after standard freezing (−20°C) (baseline condition). In a subsequent pilot study, during January–February, 2014, we delivered respiratory specimen collection kits to 53 pregnant women with a medically attended acute respiratory illness using three delivery methods.

Results

CT values were stable after storage at temperatures <27°C for up to 72 hours for influenza A viruses and 48 hours for influenza B viruses. Of 53 women who received kits during the pilot, 89% collected and shipped nasal swabs as requested. However, 30% (14/47) of the women took over 2 days to collect and ship their specimen. The human control gene, ribonuclease P (RNase P), was detected in 100% of nasal swab specimens. However, the mean CT values for RNase P (26·5, 95% confidence interval [CI] = 26·0–27·1) and for the 8 influenza A virus positives in our pilot (32·2, 95% CI = 28·9–35·5) were significantly higher than the CTs observed in our 2010–2012 study using staff-collected nasal pharyngeal swabs (P-values < 0·01).

Discussion

Self-collection of respiratory specimens is a promising research method, but further research is needed to quantify the sensitivity and specificity of the approach.     

湖北地区医务人群严重急性呼吸道综合征冠状病毒血清学调查分析

目的 确定医务人群中是否存在严重急性呼吸道综合征(SARS)冠状病毒(SARS-CoV)隐性或亚临床感染及健康带毒者。方法 以问卷调查方式抽样调查湖北地区有可能接触SARS—CoV的高危医务人群的流行病学状况；以酶联免疫吸附法测定血清SARS-CoV IgM、IgG；以一步法双重RT—PCR检测受试者喉漱液是否存在SARS-CoV。结果 接受调查的102名医务人员中，均曾在抗SARS一线工作过，9名曾到过SARS流行疫区，84名(82．3％)在2003年SARS流行期间，否认曾与确诊SARS患者有过接触；18名报告与确诊SARS患者有过接触，其中1名曾无防护接触过数天，但无任何不适，其他17名均为有防护接触，其中3名在接触后20天内曾有过感冒样不适。全部102名受调查者的血清SARS—CoV IgM、IgG以及喉漱液SARS-CoV检测均为阴性。结论 本次抽样调查未发现湖北地区医务人群中曾经有过SARS-CoV隐性或亚临床感染，也未发现有上呼吸道SARS—CoV健康带毒的情况。