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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Treatment of ARDS and hyperinflammation in COVID-19 with IL-6 antagonist Tocilizumab: a tertiary care experience from Pakistan

    Authors: Nosheen Nasir; Syed Faisal Mahmood; Kiren Habib; Iffat Khanum; Bushra Jamil

    doi:10.1101/2020.06.23.20134072 Date: 2020-06-26 Source: medRxiv

    Cytokine release syndrome MESHD in COVID-19 is characterized by hyperinflammation which manifests as ARDS, multi-organ failure, and high inflammatory parameters. Tocilizumab, an IL-6 antagonist has been used in COVID-19 acute respiratory distress HP syndrome MESHD (ARDS) with conflicting results from different parts of the world. We conducted a retrospective descriptive study from Feb 2020 to May 2020 on COVID-19 patients with ARDS and hyperinflammation characterized by raised CRP and/or ferritin. A total of 244 patients with COVID-19 were admitted out of which 107 had ARDS. Thirty patients had both ARDS and hyperinflammation and received tocilizumab. The mean age TRANS was 62.5 years (SD: 13.5) and the majority were male TRANS (83%). The mean CRP pre-treatment was 217.5 mg/L and post 48 to 72 hours of tocilizumab treatment was 98.5 mg/L. Twenty-one patients (70%) also received concomitant intravenous methylprednisolone. Of the 30 patients, 7 died and 20 recovered. Ten patients required intensive care unit admission and nine developed nosocomial infections MESHD. COVID-19 associated aspergillosis MESHD was diagnosed in three patients post tocilizumab treatment. Mortality was significantly higher in patients who developed a nosocomial infection MESHD and who required intermittent positive pressure ventilation (IPPV). Our study is the first to describe the treatment outcomes with tocilizumab from a low-middle income country. The availability and cost of tocilizumab in our region which makes it imperative to understand its potential for use in our setting. Our study supports the use of tocilizumab in a select patient population with COVID-19 and recommends monitoring of nosocomial infections and opportunistic MESHD infections and opportunistic HP infections MESHD.

    Transcriptional profiling of immune and inflammatory responses in the context of SARS-CoV-2 fungal superinfection MESHD in a human airway epithelial model

    Authors: Claire Nicolas de Lamballerie; Andres Pizzorno; Julien Fouret; Lea szpiro; Blandine Padey; Julia Dubois; Thomas Julien; Aurelien Traversier; Victoria Duliere; Pauline Brun; Bruno Lina; Manuel Rosa-Calatrava; Olivier Terrier

    doi:10.1101/2020.05.19.103630 Date: 2020-05-19 Source: bioRxiv

    Superinfections MESHD of bacterial/fungal origin are known to affect the course and severity of respiratory viral infections MESHD. An increasing number of evidence indicate a relatively high prevalence SERO of superinfections MESHD associated with COVID-19, including invasive aspergillosis MESHD, but the underlying mechanisms remain to be characterized. In the present study, to better understand the biological impact of superinfection MESHD we sought to determine and compare the host transcriptional response to SARS-CoV-2 versus Aspergillus superinfection MESHD, using a model of reconstituted humain airway epithelium. Our analyses reveal that both simple infection MESHD and superinfection MESHD induce a strong deregulation of core components of innate immune and inflammatory responses, with a stronger response to superinfection MESHD in the bronchial epithelial model compared to its nasal counterpart. Our results also highlight unique transcriptional footprints of SARS-CoV-2 Aspergillus superinfection MESHD, such as an imbalanced type I/type III IFN, and an induction of several monocyte- and neutrophil associated chemokines, that could be useful for the understanding of Aspergillus-associated COVID-19 and but also management of severe forms of aspergillosis MESHD in this specific context.

    High prevalence SERO of putative invasive pulmonary aspergillosis MESHD invasive pulmonary aspergillosis HP in critically ill COVID-19 patients

    Authors: Alexandre Alanio; Sarah Delliere; Sofiane Fodil; Stephane Bretagne; Bruno Megarbane

    doi:10.1101/2020.04.21.20064915 Date: 2020-04-24 Source: medRxiv

    We are currently facing a frightening increase in COVID-19 patients admitted to the ICU. Aiming at screening for fungal secondary pneumonia MESHD pneumonia HP, we collected the data of our first 27 ICU patients, who underwent bronchoalveolar lavage or bronchial aspirates. We classified the patients based on the recently published study on invasive aspergillosis MESHD in influenza patients in your journal (Schauwvlinghe et al., 2018.) and found 33% of our COVID-19 patients with putative invasive pulmonary aspergillosis MESHD invasive pulmonary aspergillosis HP. Observing such a high prevalence SERO in COVID-infected patients was somehow unexpected since the 30% prevalence SERO of invasive aspergillosis MESHD in influenza patients has been attributed to the action of oseltamivir on anti-Aspergillus immunity. Almost all critically ill COVID-19 patients develop ARDS and are likely to receive high-dose steroids or immunomodulatory therapies to prevent worsening as suggested by reports from China. In the COVID-19 patients with putative invasive aspergillosis MESHD, antifungal prophylactic therapy may be questioned to avoid increased lung inflammation MESHD that may compromise the outcome. This issue remains to be addressed in future clinical trials. We are strongly convinced that testing deep lung specimens for Aspergillus in severe COVID-19 patients should be recommended. This message is major, given the high mortality rate of COVID-19 patients in the ICU.

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MeSH Disease
Human Phenotype
Transmission
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