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Overview

MeSH Disease

Human Phenotype

Transmission

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Seroprevalence
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    Suspected Serious Adverse Drug Reactions in Hospitalized COVID-19 Patients

    Authors: Elena Ramírez; Mikel Urroz; Amelia Rodríguez Mariblanca; Alberto Martín-Vega; Yuri Villán; Enrique Seco; Jaime Monserrat; Jesús Frías; Antonio J. Carcas; Alberto M. Borobia

    id:10.20944/preprints202008.0283.v1 Date: 2020-08-12 Source: Preprints.org

    BACKGROUND: From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious adverse drug reactions (SADRs) in COVID-19 patients versus non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019. METHODS: All ALSs that reflected potential SADRs (including neutropenia MESHD neutropenia HP, pancytopenia MESHD pancytopenia HP, thrombocytopenia MESHD thrombocytopenia HP, anemia MESHD anemia HP, eosinophilia MESHD eosinophilia HP, leukocytes in cerebrospinal fluid, hepatitis MESHD hepatitis MESHD hepatitis HP, pancreatitis MESHD pancreatitis, acute HP, acute kidney injury MESHD, rhabdomyolysis MESHD rhabdomyolysis HP and hyponatremia MESHD hyponatremia HP were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients. RESULTS: The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89–816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients,95% CI 137.09–186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53–154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%). CONCLUSIONS: The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.

    SARS-CoV-2 Infection MESHD Associated Hemophagocytic Lymphohistiocytosis MESHD: An autopsy series with clinical and laboratory correlation.

    Authors: Andrey Prilutskiy; Michael Kritselis; Artem Shevtsov; Ilyas Yambayev; Charitha Vadlamudi; Qing Zhao; Yachana Kataria; Shayna Sarosiek; Adam Lerner; John Mark Sloan; Karen Quillen; Eric Burks

    doi:10.1101/2020.05.07.20094888 Date: 2020-05-12 Source: medRxiv

    Background: A subset of COVID-19 patients exhibit clinical features of cytokine storm. However, clinicopathologic features diagnostic of hemophagocytic lymphohistiocytosis MESHD (HLH) have not been reported. Pathologic studies to date have largely focused on the pulmonary finding of diffuse alveolar damage (DAD). To this aim, we study the reticuloendothelial organs of four consecutive patients dying of COVID-19 and correlate with clinical and laboratory parameters to detect HLH. Methods: Autopsies restricted to chest and abdomen were performed on four patients who succumbed to COVID-19. Spleen, liver, and multiple pulmonary hilar/mediastinal lymph nodes were sampled in all cases. Bone marrow was obtained by rib squeeze in a subset of cases. Routine H&E staining as well as immunohistochemical staining for CD163 was performed to detect hemophagocytosis HP. Clinical and laboratory results from pre-mortem blood SERO samples were used to calculate H-scores. Findings: All four cases demonstrated DAD within the lungs. Three of the four cases had histologic evidence of hemophagocytosis HP within pulmonary hilar/mediastinal lymph nodes. One case showed hemophagocytosis HP in the spleen but none showed hemophagocytosis HP in liver or bone marrow. Lymphophagocytosis was the predominant form of hemophagocytosis HP observed. One patient showed diagnostic features of HLH with an H-score of 217 while a second patient was likely HLH with a partial H-score of 145 due to missing triglyceride level. Both patients exhibited high fever MESHD fever HP and early onset rise in serum SERO ferritin; however, neither bicytopenia, pancytopenia MESHD pancytopenia HP, nor hypofibrinogenemia HP were observed in either. The remaining two patients had H-scores of 131 and 96. Interpretation: This is the first report of SARS-CoV-2 associated HLH. Identification of HLH in a subset of patients with severe COVID-19 will inform clinical trials of therapeutic strategies.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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