Impacto de la utilización de fármacos inmunosupresores en la covid-19 sobre la reactivación de infección tuberculosa latente y virus de la Hepatitis B

Resumen del trabajo: Existe evidencia del beneficio en términos de mortalidad que supone el uso de distintos fármacos inmunosupresores para tratar las formas graves de la enfermedad por SARS-CoV-2 (COVID-19). Aunque el uso crónico de estos fármacos aumenta el riesgo de reactivar infecciones latentes como Mycobacterium tuberculosis (MT) o virus de la B (VHB), existe poca evidencia acerca del riesgo que supone su empleo durante cortos períodos de tiempo, como en la COVID-19. Para esclarecer esto, se llevó a cabo un estudio de cohortes retrospectivo con 310 pacientes hospitalizados por COVID-19 en el Hospital San Cecilio de Granada. Todos presentaban un estudio de infección tuberculosa latente (ITL) con ensayo de liberación de interferón ¿ (IGRA) realizado durante el ingreso: 233 con resultado negativo, 38 positivo y 39 indeterminado. 68 pacientes tenían además un estudio serológico frente a VHB: 1 tenía infec ción crónica y 38 una infección pasada. Tras dos años de seguimiento, 2 pacientes, usuarios de corticoterapia crónica, habían desarrollado tuberculosis (TB) pulmonar, y no se identificó ningún caso de reactivación de VHB. Se necesitan estudios más amplios para conocer el papel de los inmunosupresores utilizados en la COVID-19 en la reactivación de estas infecciones

Lung Ultrasound, Clinical and Analytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort

At the moment, several COVID-19 scoring systems have been developed. It is necessary to determine which one better predicts a poor outcome of the disease. We conducted a single-center prospective cohort study to validate four COVID-19 prognosis scores in adult patients with confirmed infection at ward. These are National Early Warning Score (NEWS) 2, Lung Ultrasound Score (LUS), COVID-19 Worsening Score (COWS), and Spanish Society of Infectious Diseases and Clinical Microbiology score (SEIMC Score). Our outcomes were the combined variable “poor outcome” (noninvasive mechanical ventilation, intubation, intensive care unit admission, and death at 28 days) and death at 28 days. Scores were analysed using univariate logistic regression models, receiver operating characteristic curves, and areas under the curve. Eighty-one patients were included, from which 21 had a poor outcome, and 9 died. We found a statistically significant correlation between poor outcome and NEWS2, LUS > 15, and COWS. Death at 28 days was statistically correlated with NEWS2 and SEIMC Score although COWS also performs well. NEWS2, LUS, and COWS accurately predict poor outcome; and NEWS2, SEIMC Score, and COWS are useful for anticipating death at 28 days. Lung ultrasound is a diagnostic tool that should be included in COVID-19 patients evaluation

Ultrasound findings of lung ultrasonography in COVID-19: A systematic review.

To identify the defining lung ultrasound (LUS) findings of COVID-19, and establish its association to the initial severity of the disease and prognostic outcomes. Systematic review was conducted according to the PRISMA guidelines. We queried PubMed, Embase, Web of Science, Cochrane Database and Scopus using the terms ((coronavirus) OR (covid-19) OR (sars AND cov AND 2) OR (2019-nCoV)) AND (("lung ultrasound") OR (LUS)), from 31st of December 2019 to 31st of January 2021. PCR-confirmed cases of SARS-CoV-2 infection, obtained from original studies with at least 10 participants 18 years old or older, were included. Risk of bias and applicability was evaluated with QUADAS-2. We found 1333 articles, from which 66 articles were included, with a pooled population of 4687 patients. The most examined findings were at least 3 B-lines, confluent B-lines, subpleural consolidation, pleural effusion and bilateral or unilateral distribution. B-lines, its confluent presentation and pleural abnormalities are the most frequent findings. LUS score was higher in intensive care unit (ICU) patients and emergency department (ED), and it was associated with a higher risk of developing unfavorable outcomes (death, ICU admission or need for mechanical ventilation). LUS findings and/or the LUS score had a good negative predictive value in the diagnosis of COVID-19 compared to RT-PCR. The most frequent ultrasound findings of COVID-19 are B-lines and pleural abnormalities. High LUS score is associated with developing unfavorable outcomes. The inclusion of pleural effusion in the LUS score and the standardisation of the imaging protocol in COVID-19 LUS remains to be defined