Severe COVID-19

Introduction: There are substantial variabilities of the clinical characteristics and outcomes of severe coronavirus disease (COVID-19) creating difficulty to do an optimal assessment of this condition. We reviewed the current English literature to quantify the findings of baselines characteristics and health outcomes of patients with severe COVID-19 primarily with acute respiratory distress syndrome (ARDS). Methods: We examined only studies that assessed patients with proven COVID-19 by RT-PCR by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with at least one of the following severity criteria: severe COVID-19, treated in the ICUs, ARDS and/or invasive mechanical ventilation (IMV) treatment. We assessed the quality of the studies according to the National Heart, Lung and Blood Institute, Study Quality Assessment Tools. Results: Seven of 39 studies fulfilled the inclusion criteria. These seven studies included a total 1,863 patients, the median age was 63.5 years (49-70). A total 370 (19.8%) were females. Four studies were from the USA, two from China and one from Italy. Comorbidities were reported in six studies. Fever was reported in five studies and it was present in 159 out of 272 patients. Cough and shortness of breath (SOB) were reported in four studies, they were present in 111 out of 142 and 100 out of 142 of patients respectively. The median of total lymphocytes was reported in five studies with a range of 400 – 889/ul. IMV ranged from 15% to 100% and mortality ranged from 14.6% to 88%. In a subgroup analysis by countries, patients from the US showed more comorbidities, higher percent of IMV and mortality. The assessment quality score of the seven studies was (5), for a total score of (8). Conclusions: Severe COVID-19 was predominantly seen in male patients who were 60 years and older associated with comorbidities. Most of the patients were admitted at the ICU, needed IMV support due to ARDS and had a mortality range of 14.6-88%

Association of Lung cancer with Pneumonia and Chlamydia pneumoniae infection

Introduction: The degree of association and type of causal versus non-causal relationship between pneumonia and lung cancer (LC) are evolving discussions. We reviewed English publications on the degree of association between pneumonia and subsequent LC. Methods: We searched the PubMed database using key words for pneumonia, LC, and chlamydia infection. We selected peer-reviewed studies of patients with pneumonia and LC. Case reports and other literature reviews were excluded from this review. Results: Five studies examined the incidence and/or risk of LC for a total of 415,750 patients, and four studies examined cases with Chlamydia pneumoniae chronic infection at the time of diagnosis of LC for a total of 1,467 patients. The overall risk and/or incidence of LC after pneumonia was from 2.3% to 10% for a median follow-up ranging from 109 days to 4.2 years. Three studies reported current tobacco smoking status, which ranged from 27.7% to 45% among those with LC. A history of prior malignancy was reported in 22.5% of patients with LC. Chlamydia IgA and LC were statistically non-significantly associated regardless of the age of the patients. In one study, Chlamydia HP-60 IgG \u3e 1:50 was associated with significantly increased odds of LC in two respective models (ORs of 1.34 [95% CI 1.06–1.69] and 1.30 [95% CI 1.02–1.67]). A fourth study reported C. pneumoniae IgA \u3e 64 titers to be 58%, 29%, and 5.5% among patients with LC, without LC, and healthy blood donors, respectively. Conclusions: The incidence of LC was reported to range from 2.3% to 10.3% following an episode of pneumonia. There is limited evidence of the association of chronic Chlamydia infection with LC, and Chlamydia could be a causal cofactor of LC

Pulmonary Post-Acute Sequelae of COVID-19

Introduction: Persistent symptoms have been observed in a substantial proportion of survivors of COVID-19 since relatively early in the pandemic. Among these post-acute sequelae of COVID-19 (PASC), respiratory symptoms appear to be the most prevalent. Methods: We conducted a literature review of peer-reviewed publications in English on the clinical and epidemiological features of respiratory PASC in cohorts of 100 or more patients with a follow-up of four weeks or more after acute infection. Included studies reported the prevalence of persistent respiratory symptoms and/or the results of follow-up pulmonary function tests. Results: On our review included 14 studies across eight countries with a total of 2,380 patients. Subacute PASC was reported in 876 patients, and chronic PASC in 1,504 patients. The median age ranged from 44 to 67 years. The most common symptoms observed were fatigue (44%), dyspnea (40%), and cough (22%). Lung disease as a comorbidity was found in 13% of patients on average. Predominance of males was seen in all studies of subacute PASC and six out of eight studies of chronic PASC. The rates of comorbidities for subacute vs. chronic PASC were: hypertension 32% vs. 31%, cardiovascular disease 10% vs. 7%, diabetes mellitus 15% vs. 12%, kidney disease 7% vs. 4%, and lung disease 19% vs. 10%. Conclusion: Respiratory PASC seems to be more predominant as a chronic presentation, more common in male adults, and less common in older persons. Respiratory PASC is most often associated with fatigue, dyspnea, and cough. There was no strong correlation of severity of illness, acute respiratory distress syndrome, or intensive care unit admission with respiratory PASC

The Importance of Cycle Threshold Values in the Evaluation of Patients with Persistent Positive PCR for SARS-CoV-2: Case Study and Brief Review

Some patients recovered from COVID-19 but the reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 remains persistently positive. In the evaluation of these patients it is important to define the cycle threshold (Ct) value of the RT-PCR test. This article will present a case study, address relevant findings and interpretation of the RT-PCR test, and define the use of Ct values in defining when a healthcare working may return to work. Our current approach is to allow to return to work healthcare workers with persistently positive RT-PCR if the Ct values are greater than 35

Gastrointestinal SARS CoV-2 Infection and The Dynamic of Its Detection in Stool

Introduction: SARS-CoV-2 has been strongly associated with respiratory illnesses however the SARS-CoV-2 infection of the gastrointestinal tract is not fully clear. We examined the frequency of positive stool SARS-CoV-2 RT-PCR in COVID-19 patients, duration of the stool viral shedding after the viral clearance of the respiratory samples and its association with gastrointestinal symptoms Methods: We did a search in PubMed and Google Scholar of studies published in the English language before June 30th, 2020. Search queries included: “COVID-19”, “SARS-CoV-2”, and “stool SARS-CoV-2 RT-PCR”. We excluded studies with less than 8 patients from our review. Results: Among the 707 patients who had respiratory samples positive for SARS-CoV-2, 361 (51%) patients tested positive through stool SARS CoV-2 RT-PCR. From the 198 patients who tested positive for SARS-CoV-2 in stool, 101 (51%) patients continued testing positive after respiratory samples were negative through SARS-CoV-2 RT-PCR. The longest duration of positive SARS-CoV-2 in stool was 48 days and 33 days after the negative upper respiratory samples. Out of 200 patients who had positive fecal PCR for SARS-CoV-2, 95 patients (47.5%) had at least one gastrointestinal manifestation. Conclusions: About a half of COVID-19 patients had positive stool SARS-CoV-2 RT-PCR and 51% of patients had positive stool SARS CoV-2 RT-PCR after the respiratory samples became negative for SARS-CoV-2 RT-PCR. At least one GI symptom was reported in 47.5% of patients with a positive stool SARS-CoV-2 RT-PCR

Gastrointestinal Symptoms in Patients with COVID-19

Introduction: Though coronavirus disease 2019 (COVID-19) is predominantly a respiratory illness, a growing number of studies reported gastrointestinal (GI) symptoms among these patients. We examined the incidence of GI symptoms in patients with COVID-19 and the GI symptoms as the initial presentation of the disease. Methods: We examined peer reviewed studies in English of patients with COVID-19 that reported GI symptoms. We searched PubMed and Google Scholar for articles published up to June 30, 2020 by using the keywords ‘COVID-19’, ‘Coronavirus’, severe acute respiratory syndrome coronavirus 2 ‘SARS-CoV-2’, ‘gastrointestinal tract’, ‘gastrointestinal diseases’, ‘gastrointestinal symptoms and signs’. Studies with less than 30 patients and also those studies that did not report nausea, vomiting and diarrhea were excluded. Results: We reviewed 26 studies that reported GI symptoms among patients with COVID-19. Twenty-three studies were from China and the three remaining studies were from three different countries: US, France and South Korea. The mean age of patients was 47.2 years and 50.3% were females. From a total of 7,212 patients, 672 patients had nausea or/and vomiting (8.7%) and 732 (9.5%) had diarrhea. 6.8% of patients had GI symptoms as the initial presentation of COVID-19. Conclusion: GI symptoms are not common in COVID-19 patients. However, the recognition of GI symptoms may significantly help in implementing steps for preventing SARS CoV-2 transmission. Testing for COVID-19 in patients presenting with only GI symptoms may help detect and prevent spreading of the COVID-19