Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms.
74 例冠状病毒感染者的流行病学、临床和病毒学特征 2019 (新型冠状病毒肺炎) 与胃肠道症状。
- 作者列表："Jin X","Lian JS","Hu JH","Gao J","Zheng L","Zhang YM","Hao SR","Jia HY","Cai H","Zhang XL","Yu GD","Xu KJ","Wang XY","Gu JQ","Zhang SY","Ye CY","Jin CL","Lu YF","Yu X","Yu XP","Huang JR","Xu KL","Ni Q","Yu CB","Zhu B","Li YT","Liu J","Zhao H","Zhang X","Yu L","Guo YZ","Su JW","Tao JJ","Lang GJ","Wu XX","Wu WR","Qv TT","Xiang DR","Yi P","Shi D","Chen Y","Ren Y","Qiu YQ","Li LJ","Sheng J","Yang Y
OBJECTIVE:The SARS-CoV-2-infected disease (COVID-19) outbreak is a major threat to human beings. Previous studies mainly focused on Wuhan and typical symptoms. We analysed 74 confirmed COVID-19 cases with GI symptoms in the Zhejiang province to determine epidemiological, clinical and virological characteristics. DESIGN:COVID-19 hospital patients were admitted in the Zhejiang province from 17 January 2020 to 8 February 2020. Epidemiological, demographic, clinical, laboratory, management and outcome data of patients with GI symptoms were analysed using multivariate analysis for risk of severe/critical type. Bioinformatics were used to analyse features of SARS-CoV-2 from Zhejiang province. RESULTS:Among enrolled 651 patients, 74 (11.4%) presented with at least one GI symptom (nausea, vomiting or diarrhoea), average age of 46.14 years, 4-day incubation period and 10.8% had pre-existing liver disease. Of patients with COVID-19 with GI symptoms, 17 (22.97%) and 23 (31.08%) had severe/critical types and family clustering, respectively, significantly higher than those without GI symptoms, 47 (8.14%) and 118 (20.45%). Of patients with COVID-19 with GI symptoms, 29 (39.19%), 23 (31.08%), 8 (10.81%) and 16 (21.62%) had significantly higher rates of fever >38.5°C, fatigue, shortness of breath and headache, respectively. Low-dose glucocorticoids and antibiotics were administered to 14.86% and 41.89% of patients, respectively. Sputum production and increased lactate dehydrogenase/glucose levels were risk factors for severe/critical type. Bioinformatics showed sequence mutation of SARS-CoV-2 with m6A methylation and changed binding capacity with ACE2. CONCLUSION:We report COVID-19 cases with GI symptoms with novel features outside Wuhan. Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.
目的: SARS-CoV-2-infected病 (新型冠状病毒肺炎) 暴发是对人类的重大威胁。以往的研究主要集中在武汉和典型症状。我们分析了浙江省 74 例确诊的新型冠状病毒肺炎例有胃肠道症状的病例，以确定流行病学、临床和病毒学特征。 设计: 从 2020 年 1 月 17 日至 20 年 2 月 8 日，浙江省共收治新型冠状病毒肺炎例住院患者。使用多变量分析严重/危重类型的风险来分析具有GI症状的患者的流行病学、人口统计学、临床、实验室、管理和结果数据。利用生物信息学方法分析了浙江省SARS-CoV-2 的特征。 结果: 在纳入的 651 例患者中，74 例 (11.4%) 出现至少一种胃肠道症状 (恶心、呕吐或腹泻)，平均年龄 46.14 岁，4 天的潜伏期，10.8% 的患者已有肝脏疾病。有GI症状的新型冠状病毒肺炎例患者中，分别有 17 例 (22.97%) 和 23 例 (31.08%) 出现重度/危重类型和家族聚集性，显著高于无GI症状者 47 例 (8.14%) 和 118 (20.45%)。新型冠状病毒肺炎例有胃肠道症状的患者中，29 例 (39.19%) 、 23 例 (31.08%) 、 8 例 (10.81%) 和 16 例 (21.62%) 发热> 38.5 ℃ 、乏力、呼吸急促和头痛。低剂量糖皮质激素和抗生素分别给予 14.86% 和 41.89% 的患者。痰液产生和乳酸脱氢酶/葡萄糖水平升高是严重/危重型的危险因素。生物信息学显示m6A甲基化的SARS-CoV-2 的序列突变和与ace2 的结合能力改变。 结论: 我们报告了武汉以外新型冠状病毒肺炎例具有新特征的胃肠道症状。对具有非经典症状的新型冠状病毒肺炎患者的关注应该增加，以保护健康提供者。
METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.