Corpus overview


MeSH Disease

Human Phenotype


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    Etiology and antimicrobial resistance of secondary bacterial infections MESHD in patients hospitalized with COVID-19 in Wuhan, China: A retrospective analysis

    Authors: Jie Li; Junwei Wang; Yi Yang; Peishan Cai; Jingchao Cao; Xuefeng Cai; Yu Zhang

    doi:10.21203/ Date: 2020-07-23 Source: ResearchSquare

    Background: A considerable proportion of patients hospitalized with coronavirus disease MESHD 2019 (COVID-19) acquired secondary bacterial infections MESHD (SBIs). The etiology and antimicrobial resistance of bacteria were reported and used to provide a theoretical basis for appropriate infection MESHD therapy.Methods: This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 27 and March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission.Results: Among 1495 patients hospitalized with COVID-19, 102 (6.8%) patients had acquired SBIs, and almost half of them (49.0%, 50/102) died during hospitalization. Compared with severe patients, critical patients had a higher chance of SBIs. Among the 159 strains of bacteria isolated from the SBIs, 136 strains (85.5%) were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%, 57/159), K. pneumoniae HP (30.8%, 49/159), and S. maltophilia MESHD (6.3%, 10/159). The isolation rates of carbapenem-resistant A. baumannii and K. pneumoniae HP were 91.2% and 75.5%, respectively. Meticillin resistance was present in 100% of Staphylococcus aureus and Coagulase negative staphylococci, and vancomycin resistance was not found.Conclusions: SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the severity of illness on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae HP, were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. This was a single-center study; thus, our results should be externally examined when applied in other institutions.

    A severe coronavirus disease MESHD 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding MESHD: a case report

    Authors: Taojiang Chen; Qin Yang; Hongyu Duan

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including   nausea MESHD, diarrhea HP diarrhea MESHD, and vomiting HP vomiting MESHD. Massive gastrointestinal bleeding MESHD, however, has rarely been reported. Case presentation: We herein describe a case of severe SARS-CoV-2 infected MESHD patient with several risk factors for poor prognosis, including male TRANS, hypertension HP hypertension MESHD, old age TRANS, mixed bacterial infection MESHD and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding MESHD occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia HP hematochezia MESHD was uncontrolled. The patient rapidly deteriorated, suffered cardiac arrest HP cardiac arrest MESHD, and expired. Conclusions: Digestive symptoms could be severe in SARS-CoV-2 infected MESHD patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection MESHD through faecal-oral transmission TRANS should be implemented in the process of patient care and infection MESHD control.

    Unusual Presentation of Kawasaki Disease MESHD with Multisystem Inflammation MESHD and Antibodies SERO Against Severe Acute Respiratory Syndrome MESHD Coronavirus 2: A Case Report

    Authors: Haena Kim; Jung Yeon Shim; Jae-Hoon Ko; Aram Yang; Jae Won Shim; Deok Soo Kim; Hye Lim Jung; Ji Hee Kwak; In Suk Sol

    doi:10.21203/ Date: 2020-07-12 Source: ResearchSquare

    Background: Since mid-April 2020, cases of multisystem inflammatory syndrome MESHD in children TRANS (MIS-C) associated with coronavirus disease MESHD (COVID-19) that mimic Kawasaki disease MESHD ( KD MESHD) have been reported in Europe and North America. However, no cases have been in East Asia, where KD MESHD is more prevalent.Case presentation: A previously healthy 11-year-old boy was admitted with a 4-day history of fever HP fever MESHD and abdominal pain HP abdominal pain MESHD. He had no contact history to any patient with COVID-19. Blood SERO acute inflammatory markers were highly elevated. He was treated with antibiotics for suspected bacterial enteritis MESHD, but he suddenly developed hypotension HP hypotension MESHD. Inotropics and intravenous immunoglobulin were administered to manage septic shock MESHD shock HP. On hospitalization day 6, he developed signs and symptoms of KD MESHD (conjunctival injection, strawberry tongue HP, cracked lip MESHD, and coronary artery dilatation MESHD dilatation HP) in addition to pleural/pericardial effusion MESHD pericardial effusion HP and mesenteric lymphadenitis HP lymphadenitis MESHD. The results of microbiologic tests, including reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), were negative. Fluorescent immunoassay SERO and enzyme-linked immunosorbent assay SERO revealed abundant IgG antibodies SERO against SARS-CoV-2 in his serum SERO, but no IgM antibodies SERO. He was discharged successfully on day 13.Conclusion: MIS-C may occur in children TRANS with a previously asymptomatic TRANS COVID-19 infection MESHD. A high index of suspicion is required for this novel syndrome in unusual cases of KD MESHD or KD shock syndrome MESHD shock HP syndrome with multisystem inflammation MESHD, even when there is no clear history of contact or symptoms of COVID-19.

    Characterization of Microbial Co-infections MESHD infections in the Respiratory Tract HP of hospitalized COVID-19 patients

    Authors: Huanzi Zhong; Yanqun Wang; Zhun Shi; Lu Zhang; Huahui Ren; Weiqun He; Zhaoyong Zhang; Airu Zhu; Jingxian Zhao; Fei Xiao; Fangming Yang; Tianzhu Liang; Feng Ye; Bei Zhong; Shicong Ruan; Mian Gan; Jiahui Zhu; Fang Li; Fuqiang Li; Daxi Wang; Jiandong Li; Peidi Ren; Shida Zhu; Huanming Yang; Jian Wang; Karsten Kristiansen; Hein M Tun; Weijun Chen; Nanshan Zhong; Xun Xu; Yi-min Li; Junhua LI; Jincun Zhao

    doi:10.1101/2020.07.02.20143032 Date: 2020-07-05 Source: medRxiv

    Summary Background Severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) has caused a global pandemic of Coronavirus disease MESHD 2019 (COVID-19). However, microbial composition of the respiratory tract and other infected tissues, as well as their possible pathogenic contributions to varying degrees of disease severity in COVID-19 patients remain unclear. Method Between January 27 and February 26, 2020, serial clinical specimens (sputum, nasal and throat swab, anal swab and feces) were collected from a cohort of hospitalized COVID-19 patients, including 8 mildly and 15 severely ill patients (requiring ICU admission and mechanical ventilation), in the Guangdong province, China. Total RNA was extracted and ultra-deep metatranscriptomic sequencing was performed in combination with laboratory diagnostic assays. Co-infection MESHD rates, the prevalence SERO and abundance of microbial communities in these COVID-19 patients were determined. Findings Notably, respiratory microbial co-infections MESHD were exclusively found in 84.6% of severely ill patients (11/13), among which viral and bacterial co-infections MESHD were detected by sequencing in 30.8% (4/13) and 69.2% (9/13) of the patients, respectively. In addition, for 23.1% (3/13) of the patients, bacterial co-infections MESHD with Burkholderia cepacia complex (BCC) and Staphylococcus epidermidis MESHD were also confirmed by bacterial culture. Further, a time-dependent, secondary infection of B. cenocepacia with expressions of multiple virulence genes in one severely ill patient was demonstrated, which might be the primary cause of his disease deterioration and death MESHD one month after ICU admission. Interpretation Our findings identified distinct patterns of co-infections MESHD with SARS-CoV-2 and various respiratory pathogenic microbes in hospitalized COVID-19 patients in relation to disease severity. Detection and tracking of BCC-associated nosocomial infections MESHD are recommended to improve the pre-emptive treatment regimen and reduce fatal outcomes of hospitalized patients infected with SARS-CoV-2. Funding National Science and Technology Major Project of China, National Major Project for Control and Prevention of Infectious Disease MESHD in China, the emergency grants for prevention and control of SARS-CoV-2 of Ministry of Science and Technology and Guangdong province, Guangdong Provincial Key Laboratory of Genome Read and Write, Guangdong Provincial Academician Workstation of BGI Synthetic Genomics, and Shenzhen Engineering Laboratory for Innovative Molecular Diagnostics.

    Clinical characteristics of hospitalized patients with COVID-19 in Yueyang, Hunan, China

    Authors: Chenglong Ge; Yuan Jiang; Qianyi Peng; Lei Wu; Kai Duan; Jing Yang

    doi:10.21203/ Date: 2020-06-23 Source: ResearchSquare

    The clinical characteristics of patients with novel coronavirus disease MESHD (COVID-19) in Hunan Province are less understood. We analyzed retrospectively the epidemiological, clinical characteristics, and risk factors associated with severity of 113 confirmed COVID-19 cases in Yueyang, Hunan Province, China, from January 20, 2020, to March 8, 2020, and followed until April 13, 2020. Of the 113 confirmed cases TRANS, 92 (81.4%) were from or infected by patients from Hubei province. More than half (63) of patients with COVID-19 had no fever HP fever MESHD in the early stages of disease. 23% patients had no symptoms at the onset TRANS. As of March 8, 2020, 113 (100%) of 113 patients had met the discharge criteria, 0 (0%) patients died. Compared with the non-severe cases, severe cases were associated with older age TRANS or patients with comorbidities, secondary bacterial infections MESHD, and higher levels of C-reactive protein. Longer duration of virus clearance was associated with a higher risk of progression to critical status. Older patients or patients with comorbidities such as diabetes MESHD were more likely to have severe condition. Prompt and effective treatment and sufficient medical resources may still significantly reduce hospital-related transmissions TRANS and mortality.

    Experience of N-acetylcysteine airway management in the successful treatment of one case of critical condition with COVID-19

    Authors: Yan Liu; Guoshi Luo; Xin Qian; Chenglin Wu; Yijun Tang; kun lu; Biyu Chen; Elaine Lai-Han Leung; Meifang Wang

    doi:10.21203/ Date: 2020-06-08 Source: ResearchSquare

    Object: To report the successful diagnosis and treatment of a patient with critical condition of novel coronavirus pneumonia MESHD pneumonia HP (COVID-19) and to summarize its clinical features and airway management experience in successful treatment.Methods: Retrospectively analyzed the successful management of one case of COVID-19 with critical condition combined respiratory failure HP respiratory failure MESHD and discussed the clinical characteristics and airway management of the patient in conjunction with a review of the latest literature.Results: A patient with an anastomotic fistula MESHD after radical treatment of esophageal cancer MESHD and right-side encapsulated pyopneumothorax was admitted with cough HP and dyspnea HP dyspnea MESHD and was diagnosed with novel coronavirus pneumonia MESHD pneumonia HP and malnutrition HP malnutrition MESHD by pharyngeal swab nucleic acid test in combination with chest CT. The patient was treated with antibiotics, antiviral and antibacterial medications, respiratory support, expectorant nebulization, and nutritional support, expressed progressive deterioration. Endotracheal intubation and mechanical ventilation were performed since the onset of the type Ⅱ respiratory failure HP on the 13th day of admission. The patient had persistent refractory hypercapnia HP hypercapnia MESHD after mechanical ventilation. Based on the treatment mentioned above, combined with repeated bronchoalveolar lavage by using N-acetylcysteine ​​(NAC) inhalation solution, the patient's refractory hypercapnia HP hypercapnia MESHD was gradually improved. It was cured and discharged after being given the mechanical ventilation for 26 days as well as 46 days of hospitalization, currently is surviving well.Conclusion: Patients with severe conditions of novel coronavirus pneumonia MESHD pneumonia HP often encounter bacterial infection MESHD in their later illness-stages. They may suffer respiratory failure HP respiratory failure MESHD and refractory hypercapnia HP hypercapnia MESHD that is difficult to improve due to excessive mucus secretion leading to small airway obstruction. In addition to the use of reasonable antibiotics and symptomatic respiratory support and other treatment, timely artificial airway and repeated bronchoalveolar NAC inhalation solution lavage, expectorant and other airway management are essential for such patients.

    Analysis of moderate and severe cases of novel coronavirus disease MESHD (COVID-19) versus influenza A (H1N1)

    Authors: Weishun Hou; Haoyu Sheng; Manman Liang; zijian Wang; Xiuliang Xu; Yusheng Cheng; Fang Liu; Aiping Zhang; Bin Quan; Yunfeng Zhou; Jianghua Yang

    doi:10.21203/ Date: 2020-05-26 Source: ResearchSquare

    Background To analyse the clinical characteristics, laboratory tests, and imaging findings of severe cases of coronavirus disease MESHD 2019 (COVID-19) versus severe cases of influenza A (H1N1).Methods We retrospectively analysed the clinical data of moderate and severe COVID-19 and H1N1 cases between January 23 and February 23, 2020.Results A total of 33 COVID-19 cases had a clear history of exposure to severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), with an incubation period TRANS of 11.12 ± 7.47 days. A total of 29 H1N1 cases were included in this study. Most cases were sporadic, with an incubation period TRANS of 3.67 ± 0.82 days (P = 0.002). The age TRANS at onset was 19.79 ± 23.88 years for H1N1 and 43.48 ± 17.82 years for COVID-19 (P < 0.001). For H1N1, common clinical symptoms were high fever HP fever MESHD and myalgia HP myalgia MESHD. The time of disease progression from moderate to severe was 13.60 ± 5.64 days for COVID-19 and 5.25 ± 2.36 days for H1N1 (P = 0.035). Laboratory tests showed that white blood SERO cells (WBC), neutrophils (N), lactate dehydrogenase (LDH), C-reactive protein (CPR), and procalcitonin (PCT) were significantly higher in severe H1N1 cases than in severe COVID-19 cases. D-dimer (DD) was 1.43 ± 1.19 µg/mL in the COVID-19 group, which was higher than that in the H1N1 group (0.88 ± 0.32 µg/mL, P = 0.013). High-resolution computed tomography (CT) showed severe COVID-19 cases presented mainly interstitial involvement, shown by large ground-glass opacities, whereas severe H1N1 cases presented both interstitial and parenchymal involvement, especially parenchymal involvement. All the COVID-19 patients survived to discharge, and one H1N1 patient died.Conclusion Compared with H1N1 patients, COVID-19 patients had a clear history of exposure to SARS-CoV-2, were older, presented milder clinical symptoms and a slower progression, and rarely had bacterial infections MESHD. Most H1N1 patients had sporadic H1N1 with an acute onset, high fever HP, and rapid progression; secondary bacterial infection MESHD was an important cause of disease aggravation.

    Comparison of Hospitalized Patients with Severe Pneumonia MESHD Pneumonia HP Caused by COVID-19 and Highly Pathogenic Avian Influenza (H7N9): A Retrospective Study from A Designated Hospital

    Authors: Binbin Gu; Lin Yao; XinYun Zhu; Pei-jun Tang; Cheng Chen

    doi:10.21203/ Date: 2020-05-08 Source: ResearchSquare

    Background Considerable attention has been focused on clinical features of Coronavirus Disease MESHD 2019 (COVID-19), it is also important for clinicians to differentiate it from influenza virus infections MESHD.Methods The clinical data of 23 cases of H7N9 and 23 cases of COVID-19 with severe pneumonia HP pneumonia MESHD were collected. The comparisons were performed with the t test, Mann-Whitney U test, Fisher exact test or the chi-squared test, and multivariable logistic regression analysis.Results All of the cases were under the circumstance of sufficient medical staff and medical supplies. The rate of coexisting disease was lower in the severe COVID-19 group than in the severe H7N9 group (p < 0.05). Radiologically, severe COVID-19 patients had less consolidation and pleural effusion HP pleural effusion MESHD, but more crazy-paving pattern than severe H7N9 patients (p < 0.05). Clinically, compared to severe H7N9, severe COVID-19 patients were more inclined to surfer to relative better disease severity score, less secondary bacterial infection MESHD, a shorter time to beginning absorption on CT, but a longer duration of viral shedding from the admission (p < 0.05). Although more severe H7N9 patients needed non-invasive respiratory support, these two groups ultimately yielded comparable mortality. Based on multiple logistic regression analysis, severe COVID-19 infection MESHD was associated with a lower risk of the presence of severe ARDS (OR 0.964, 95% [CI] 0.931–0.998, p = 0.040), but exhibited longer duration of viral shedding (OR 0.734, 95% [CI] 0.550–0.980, p = 0.036) than severe H7N9 infection MESHD.Conclusion Although the conditions of severe H7N9 patients seemed to be more critical than those of severe COVID-19 patients, the relatively lower mortality of these two severe cases is to be expected in context of sufficient medical supplies.

    Bacteremia HP Bacteremia MESHD and Blood SERO Culture Utilization During COVID-19 Surge in New York City

    Authors: Jorge Sepulveda; Lars F Westblade; Susan Whittier; Michael Joseph Satlin; William Greendyke; Justin G Aaron; Jason E. Zucker; Donald Dietz; Magdalena E Sobieszczyk; Justin J Choi; Dakai Liu; Kelvin Espinal; Sarah Russell; Dennis Camp; Charles Connelly; Daniel A. Green

    doi:10.1101/2020.05.05.20080044 Date: 2020-05-06 Source: medRxiv

    A surge of patients with coronavirus disease MESHD 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in the utilization of blood SERO cultures, which overwhelmed the capacity of automated blood SERO culture instruments. We sought to evaluate the utilization and diagnostic yield of blood SERO cultures during the COVID-19 pandemic to determine prevalence SERO and common etiologies of bacteremia HP bacteremia MESHD, and to inform a diagnostic approach to relieve blood SERO culture overutilization. We performed a retrospective cohort analysis of 88,201 blood SERO cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the first half of the month. The rate of bacteremia HP bacteremia MESHD was significantly lower among COVID-19 patients (3.8%) than COVID-19 negative patients (8.0%) and those not tested (7.1%), p < 0.001. COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, reducing the bacteremia HP bacteremia MESHD rate to 1.6% when excluded. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood SERO cultures in the absence of compelling evidence for bacterial co-infection MESHD. Clear communication with ordering providers is necessary to prevent overutilization of blood SERO cultures during COVID-19 surges, and laboratories should consider shortening the incubation period TRANS from 5 days to 4 days to free additional capacity.

    Symptoms at disease onset predict prognosis in COVID-19 disease

    Authors: Aiyuan Zhou; Yating Peng; David R Price; Hong Peng; Xin Liao; Peng Huang; Wenlong Liu; Zhi Xiang; Qimi Liu; Mingyan Jiang; Xudong Xiang; Peipei Guo; Dingding Deng; Ping Chen

    doi:10.21203/ Date: 2020-04-24 Source: ResearchSquare

    Background: The main clinical manifestations of coronavirus disease MESHD 2019 (COVID-19) onset are respiratory symptoms, including cough HP, sputum and dyspnea HP dyspnea MESHD. However, a significant proportion of patients initially manifested extra-respiratory symptoms, such as fever HP fever MESHD, myalgia HP myalgia MESHD and diarrhea HP diarrhea MESHD. Here we compared the different characteristics and outcomes between the patients with respiratory symptoms and extra-respiratory symptoms at illness onset.Methods: The patients admitted to the respiratory departments from eight hospitals out of Wuhan with nucleic acid-positive of severe acute respiratory syndrome coronavirus (SARS-CoV-2 MESHD) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens and outcomes data were recorded and analyzed.Results: The median age TRANS of the recruited 541 subjects was 43 years (IQR, 33-55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had extra-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections MESHD (p<0.001), needed the intensive care unit more (p=0.005), non-invasive ventilation more (p=0.004), developed ARDS more (p=0.001) and needed longer to recover (p=0.003) compared to predominately extra-respiratory COVID-19 subjects. The multivariate model showed that age TRANS (OR = 1.04, p = 0.01) dyspnea HP dyspnea MESHD (OR = 4.91, p < 0.001) and secondary bacterial infection MESHD (OR = 19.8, p < 0.001) were independently associated with development of ARDS among COVID-19 patients.Conclusion: we identify COVID-19 subjects with dyspnea HP dyspnea MESHD at disease onset have worse prognosis. We also demonstrate age TRANS and secondary bacterial infections MESHD to be independently associated with ARDS development in subjects with COVID-19.

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MeSH Disease
Human Phenotype

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