Objectives
Information on the recently COVID‐19‐associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus ...disease 2019 (COVID‐19), and review the published literature from Western countries.
Methods
Prospective study (March to May, 2020) that included all COVID‐19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used.
Results
COVID‐19‐associated pulmonary aspergillosis was diagnosed in eight patients (3.3% of 239 ICU patients), mostly affected non‐immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPA‐related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher all‐cause mortality (100% vs. 40%, p = .04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%.
Conclusions
COVID‐19‐associated pulmonary aspergillosis must be considered a serious and potentially life‐threatening complication in patients with severe COVID‐19 receiving immunosuppressive treatment.
There is a paucity of knowledge on the long-term outcome in patients diagnosed with COVID-19. We describe a cohort of patients with a constellation of symptoms occurring four weeks after diagnosis ...causing different degrees of reduced functional capacity. Although different hypothesis have been proposed to explain this condition like persistent immune activation or immunological dysfunction, to date, no physiopathological mechanism has been identified. Consequently, there are no therapeutic options besides symptomatic treatment and rehabilitation.
We evaluated patients with symptoms that persisted for at least 4 weeks after COVID-19. Epidemiological and clinical data were collected. Blood tests, including inflammatory markers, were conducted, and imaging studies made if deemed necessary. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) in plasma, stool, and urine were performed. Patients were offered antiviral treatment (compassionate use).
We evaluated 29 patients who reported fatigue, muscle pain, dyspnea, inappropriate tachycardia, and low-grade fever. Median number of days from COVID-19 to positive RT-PCR in extra-respiratory samples was 55 (39-67). Previous COVID-19 was mild in 55% of the cases. Thirteen patients (45%) had positive plasma RT-PCR results and 51% were positive in at least one RT-PCR sample (plasma, urine, or stool). Functional status was severely reduced in 48% of the subjects. Eighteen patients (62%) received antiviral treatment. Improvement was seen in most patients (p = 0.000) and patients in the treatment group achieved better outcomes with significant differences (p = 0.01).
In a cohort of COVID-19 patients with persistent symptoms, 45% of them have detectable plasma SARS-CoV-2 RNA. Our results indicate possible systemic viral persistence in these patients, who may benefit of antiviral treatment strategies.
The purpose of this study was to detect coronavirus disease 2019 (COVID-19) cases with persistent positive reverse transcription-PCR (RT-PCR) results for severe acute respiratory syndrome coronavirus ...2 (SARS-CoV-2), for which viable virus can be inferred due to the presence of subgenomic (SG) viral RNA, which is expressed only in replicating viruses. RNA remnants purified from diagnostic nasopharyngeal specimens were used as the templates for RT-PCR-specific detection of SG E gene RNA. As controls, we also detected viral genomic RNA for the E gene and/or a human housekeeping gene (RNase P). We assessed the samples of 60 RT-PCR-positive cases with prolonged viral SARS-CoV-2 shedding (24 to 101 days) since the first diagnostic RT-PCR. SG viral RNA was detected in 12/60 (20%) of the persistent cases, 28 to 79 days after the onset of symptoms. The age range of the cases with prolonged viral shedding and the presence of SG RNA was quite wide (40 to 100 years), and the cases were equally distributed between males (42%) and females (58%). No case was HIV positive, although seven were immunosuppressed. According to the severities of the COVID-19 episodes, they were mild (40%), intermediate (20%), and severe (40%). In a percentage of persistent SARS-CoV-2 PCR-positive cases, the presence of actively replicating virus may be inferred, far beyond diagnosis. We should not assume a universal lack of infectiousness for COVID-19 cases with prolonged viral shedding.
Since the COVID-19 outbreak, specific mRNA-based anti-SARS-CoV-2 vaccines have been developed and distributed worldwide. Because this is the first time that mRNA vaccines have been used, there are ...several questions regarding their capacity to confer immunity and the durability of the specific anti-SARS-CoV-2 response. Therefore, the objective of this study was to recruit a large cohort of healthcare workers from the Gregorio Marañón Hospital vaccinated with the mRNA-1273 or BNT126b2 vaccines and to follow-up on IgG anti-RBD levels at 8 months post-vaccination.
We recruited 4,970 volunteers and measured IgG anti-RBD antibodies on days 30 and 240 post-vaccination.
We observed that both vaccines induced high levels of antibodies on day 30, while a drastic wane was observed on day 240, where mRNA-1273 vaccinated induced higher levels than BNT162b2. Stratifying by vaccine type, age, gender, and comorbidities, we identified that older mRNA-1273-vaccinated volunteers had higher antibody levels than the younger volunteers, contrary to what was observed in the BNT162b2-vaccinated volunteers.
In conclusion, we observed that mRNA-1273 has a higher capacity to induce a humoral response than BNT162b2 and that age is a factor in the specific response.
ABSTRACT
During the COVID-19 pandemic, several SARS-CoV-2 variants of concern (VOCs) of particular relevance emerged. Early detection of VOCs entering a country is essential to control spread. The ...alert triggered by the first suspected case of the Omicron variant in Spain in a traveler arriving from South Africa in November 2021 provided a unique opportunity to evaluate four different methodological strategies tailored to rapid identification of Omicron. The different approaches were designed to respond to the different technical resources available in different settings. First, we used melting probes in RT-PCR to determine the presence of four Omicron signatures (K417N, E484A, P681H, and absence of L452R): three probes showed deviations in temperature (Tm) values relative to the reference codons (E484K-15.8°C, P681H-5.2°C, and L452R-7.2°C) and one maintained the reference value (K417N). The deviation in Tm of P681H suggested the presence of the characteristic Omicron N679K mutation in the probe hybridization region; these data pointed to the presence of Omicron alleles. Second, the presence of 29 of the 33 characteristic single nucleotide polymorphisms (SNPs) in the Omicron variant S-gene was identified by Sanger sequencing of nine amplicons. The final two strategies involved identification of 47 of the 50 non-synonymous and indel mutations attributed to Omicron by rapid nanopore whole genome sequencing (WGS) and by Illumina WGS technology. These strategies enabled us to pre-assign the first Omicron case in Spain with high certainty 2 h after receipt of RNA and to confirm it genomically 3 h later, so that the Public Health authorities could be rapidly notified.
IMPORTANCE
The study presents different experimental alternatives to identify new variants of concern (VOCs) of SARS-CoV-2 entering a certain population. Early detection of a new VOC is crucial for surveillance and control of spread. The objective is to provide laboratories with tools adapted to their resource capabilities that offer a sufficient level of resolution to rule out, confirm, or pre-assign the presence of a suspected VOC. The study describes four different techniques that were applied simultaneously to the first suspected Omicron case in Spain, highlighting the level of resolution and response time achieved in each case. These techniques are based on the detection of mutations in the S-gene of the virus that can easily adapt to potential emerging variants. The results of the study allow any laboratory to prepare for new alerts of SARS-CoV-2 VOCs.
The study presents different experimental alternatives to identify new variants of concern (VOCs) of SARS-CoV-2 entering a certain population. Early detection of a new VOC is crucial for surveillance and control of spread. The objective is to provide laboratories with tools adapted to their resource capabilities that offer a sufficient level of resolution to rule out, confirm, or pre-assign the presence of a suspected VOC. The study describes four different techniques that were applied simultaneously to the first suspected Omicron case in Spain, highlighting the level of resolution and response time achieved in each case. These techniques are based on the detection of mutations in the S-gene of the virus that can easily adapt to potential emerging variants. The results of the study allow any laboratory to prepare for new alerts of SARS-CoV-2 VOCs.
COVID-19 vaccination has proven to be effective at preventing symptomatic disease but there are scarce data to fully understand whether vaccinated individuals can still behave as SARS-CoV-2 ...transmission vectors. Based on viral genome sequencing and detailed epidemiological interviews, we report a nosocomial transmission event involving two vaccinated health care-workers (HCWs) and four patients, one of them with fatal outcome. Strict transmission control measures, as during the prevaccination period, must be kept between HCWs and HCWs-patients in nosocomial settings.
COVID-19 vaccination has proven to be effective at preventing symptomatic disease. Although some transmission events involving vaccinated cases have also been reported, scarce information is still available to fully understand whether vaccinated individuals may still behave as vectors in SARS-CoV-2 transmission events. Here, we report a SARS-CoV-2 nosocomial transmission event, supported on whole genome sequencing, in early March 2021 involving two vaccinated HCWs and four patients in our institution. Strict transmission control measures between HCWs and HCWs - patients in nosocomial settings must not be relaxed, and should be kept as strictly as during the prevaccination period.
Introduction: infectious endocarditis is one of the main prototypes of cardiovascular diseases not only on a global scale, but also at a national level.Objective:to characterize clinically and ...epidemiologically the adolescents diagnosed with infectious endocarditis treated at North Pediatric Hospital of Santiago de Cuba from 2010 to 2017.Method: an observational, descriptive and cross-sectional study was carried out. The target group comprised 20 adolescents with the diagnosis of infectious endocarditis treated at Norte Pediatric Hospital of Santiago de Cuba during the period 2010 to 2017. The information was collected from the medical records.Results: the age group of 10 to 12 years (45 %) and male sex (65 %) predominated. Fever and tachycardia were the most frequent clinical manifestations, present in 100 % of adolescents. Ventricular septal defect constituted the most significant comorbidity with 30 %. Blood cultures were positive in 75 % of the cases; there was only one patient who died in the series (5 %) and 75 % progressed satisfactorily to health recovery.Conclusions: infectious endocarditis in adolescence is more frequent in males, having several forms of presentation; it is also directly associated with the presence of other diseases, having a low mortality in the series studied.
Introducción: la endocarditis infecciosa constituye uno de los principales prototipos de las enfermedades cardiovasculares no solo a escala mundial, sino también en el ámbito nacional.Objetivo: caracterizar clínica y epidemiológicamente a los adolescentes con diagnóstico de endocarditis infecciosa atendidos en el Hospital Infantil Norte de Santiago de Cuba de 2010 a 2017.Método: se realizó un estudio observacional, descriptivo y transversal. El universo estuvo constituido por 20 adolescentes con diagnóstico de endocarditis infecciosa atendidos en el Hospital Infantil Norte de Santiago de Cuba en el período de 2010 a 2017. La información se obtuvo de las historias clínicas.Resultados: predominó el grupo de edades de 10 a 12 años (45 %) y el sexo masculino (65 %). La fiebre y la taquicardia fueron las manifestaciones clínicas más frecuentes, presentes en el 100 % de los adolescentes. La comunicación interventricular constituyó la comorbilidad más significativa con un 30 %. Los hemocultivos fueron positivos en el 75 % de los casos; solo hubo un paciente fallecido en la serie (5 %) y el 75 % evolucionó satisfactoriamente a la curación.Conclusiones: en la adolescencia la endocarditis infecciosa es más frecuente en el sexo masculino, teniendo varias formas de presentación; además se asocia directamente a la presencia de otras enfermedades, teniendo una baja mortalidad en la serie estudiada.
Introduction: infectious endocarditis is one of the main prototypes of cardiovascular diseases not only on a global scale, but also at a national level. Objective:to characterize clinically and ...epidemiologically the adolescents diagnosed with infectious endocarditis treated at North Pediatric Hospital of Santiago de Cuba from 2010 to 2017. Method: an observational, descriptive and cross-sectional study was carried out. The target group comprised 20 adolescents with the diagnosis of infectious endocarditis treated at Norte Pediatric Hospital of Santiago de Cuba during the period 2010 to 2017. The information was collected from the medical records. Results: the age group of 10 to 12 years (45 %) and male sex (65 %) predominated. Fever and tachycardia were the most frequent clinical manifestations, present in 100 % of adolescents. Ventricular septal defect constituted the most significant comorbidity with 30 %. Blood cultures were positive in 75 % of the cases; there was only one patient who died in the series (5 %) and 75 % progressed satisfactorily to health recovery. Conclusions: infectious endocarditis in adolescence is more frequent in males, having several forms of presentation; it is also directly associated with the presence of other diseases, having a low mortality in the series studied.
Introduction: infectious endocarditis is one of the main prototypes of cardiovascular diseases not only on a global scale, but also at a national level. Objective:to characterize clinically and ...epidemiologically the adolescents diagnosed with infectious endocarditis treated at North Pediatric Hospital of Santiago de Cuba from 2010 to 2017. Method: an observational, descriptive and cross-sectional study was carried out. The target group comprised 20 adolescents with the diagnosis of infectious endocarditis treated at Norte Pediatric Hospital of Santiago de Cuba during the period 2010 to 2017. The information was collected from the medical records. Results: the age group of 10 to 12 years (45 %) and male sex (65 %) predominated. Fever and tachycardia were the most frequent clinical manifestations, present in 100 % of adolescents. Ventricular septal defect constituted the most significant comorbidity with 30 %. Blood cultures were positive in 75 % of the cases; there was only one patient who died in the series (5 %) and 75 % progressed satisfactorily to health recovery. Conclusions: infectious endocarditis in adolescence is more frequent in males, having several forms of presentation; it is also directly associated with the presence of other diseases, having a low mortality in the series studied.
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