INFUSION OF CONVALESCENT PLASMA IS ASSOCIATED WITH CLINICAL IMPROVEMENT IN CRITICALLY ILL PATIENTS WITH COVID-19: A PILOT STUDY.
- 作者列表："Olivares-Gazca JC","Priesca-Marín JM","Ojeda-Laguna M","Garces-Eisele J","Soto-Olvera S","Palacios-Alonso A","Izquierdo-Vega J","Chacon-Cano R","Arizpe-Bravo D","López-Trujillo MA","Cantero-Fortiz Y","Fernandez-Lara D","Ruiz-Delgado GJ","Ruiz-Argüelles GJ
Background:The ideal treatment of coronavirus disease (COVID)-19 has yet to be defined, but convalescent plasma (CoPla) has been successfully employed. Objective:The objective of the study was to study the safety and outcomes of the administration of CoPla to individuals with severe COVID-19 in an academic medical center. Methods:Ten patients were prospectively treated with plasma from COVID-19 convalescent donors. Results:Over 8 days, the sequential organ failure assessment score dropped significantly in all patients, from 3 to 1.5 (p = 0.014); the Kirby index (PaO2/FiO2) score increased from 124 to 255, (p < 0.0001), body temperature decreased significantly from 38.1 to 36.9°C (p = 0.0058), and ferritin levels also dropped significantly from 1736.6 to 1061.8 ng/ml (p = 0.0001). Chest X-rays improved in 7/10 cases and in 6/10, computerized tomography scans also revealed improvement of the lung injury. Decreases in C-reactive protein and D-dimer levels were also observed. Three of five patients on mechanical ventilation support could be extubated, nine were transferred to conventional hospital floors, and six were sent home; two patients died. The administration of CoPla had no side effects and the 24-day overall survival was 77%. Conclusions:Although other treatments were also administered to the patients and as a result data are difficult to interpret, it seems that the addition of CoPla improved pulmonary function.
背景: 冠状病毒病 (COVID)-19 的理想治疗方法尚未确定，但恢复期血浆 (CoPla) 已成功使用。 目的: 本研究的目的是研究在学术医学中心对严重新型冠状病毒肺炎个体使用CoPla的安全性和结果。 方法: 对 10 例恢复期供体血浆进行前瞻性新型冠状病毒肺炎治疗。 结果: 超过 8 天，所有患者的序贯器官衰竭评估评分显著下降，从 3 降至 1.5 (p = 0.014); Kirby指数 (PaO2/FiO2) 评分从 124 增加到 255，(p <0.0001)，体温从 3 8.1 ℃ 显著下降到 3 6.9 ℃ (p = 0.0058)，铁蛋白水平也从 1736.6 显著下降到 1061.8 ng/ml (p = 0.0001)。胸部x光检查改善 7/10 例，6/10 例电脑断层扫描显示肺损伤改善。同时观察c-rea C蛋白和D-二聚体水平的c。5 例接受机械通气支持的患者中 3 例可以拔管，9 例转到常规医院楼层，6 例被送回家; 2 例患者死亡。CoPla给药无副作用，24 天总生存期为 77%。 结论: 尽管患者也接受了其他治疗，因此数据难以解释，但添加CoPla似乎改善了肺功能。
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.