意大利 79 例IBD患者的新型冠状病毒肺炎结局: 一项IG-IBD研究。
- 作者列表："Bezzio C","Saibeni S","Variola A","Allocca M","Massari A","Gerardi V","Casini V","Ricci C","Zingone F","Amato A","Caprioli F","Lenti MV","Viganò C","Ascolani M","Bossa F","Castiglione F","Cortelezzi C","Grossi L","Milla M","Morganti D","Pastorelli L","Ribaldone DG","Sartini A","Soriano A","Manes G","Danese S","Fantini MC","Armuzzi A","Daperno M","Fiorino G","Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD).
OBJECTIVES:COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. DESIGN:This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). RESULTS:Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. CONCLUSIONS:Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.
目的: 新型冠状病毒肺炎迅速成为世界范围内的重大卫生突发事件。IBD患者的感染风险增加，特别是当他们有活动性疾病并正在接受免疫抑制治疗时。IBD患者新型冠状病毒肺炎的特点和转归仍不清楚。 设计: 这项意大利前瞻性观察性队列研究纳入了已确诊IBD并确诊新型冠状病毒肺炎的连续患者。关于年龄、性别、IBD (类型、治疗和临床活动) 、其他合并症 (Charlson合并症指数 (CCI)) 的数据将新型冠状病毒肺炎和治疗的体征和症状与新型冠状病毒肺炎结果 (肺炎、住院、呼吸治疗和死亡) 进行比较。 结果: 在 2020 年 3 月 11 日至 29 日期间，在 24 个IBD转诊单位入组了 79 例IBD伴新型冠状病毒肺炎患者。36 例患者发生COVID-19-related肺炎 (46%)，2 2 例 (2 8%) 住院，7 例 (9%) 需要非机械通气，9 例 (11%) 需要持续气道正压通气治疗，2 例 (3%) 气管插管，6 例 (8%) 死亡。4 例患者 (6%) 因严重IBD发作入院时被诊断为新型冠状病毒肺炎。年龄超过 65 岁 (p = 0.03) 、UC诊断 (p = 0.03) 、IBD活动性 (p = 0.003) 和a CCI评分> 1 (p = 0.04) 均伴有明显的新型冠状病毒肺炎 1 9 肺炎，而随之而来的炎症性肠病 (IBD) 治疗不.年龄超过 65 岁 (p = 0.002) 、活动性IBD (p = 0.02) 和较高的CCI评分与COVID-19-related死亡显著相关。 结论: 活动性IBD、高龄和合并症与新型冠状病毒肺炎结局呈阴性相关，而IBD治疗则不然。预防急性IBD发作可能避免IBD患者的致命新型冠状病毒肺炎。还需要进一步的研究。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.