Immunocompromised patients with prolonged COVID-19 symptoms present diagnostic and therapeutic challenges. We measured viral nucleocapsid antigenemia in three patients treated with anti-CD20 immunotherapy who acquired SARS-CoV-2 infection and experienced protracted symptoms. Our results support nucleocapsid antigenemia as a marker of persistent infection and therapeutic response.
Acute gastroenteritis remains a significant cause of morbidity and mortality both in high and low-resource settings. The development of nucleic acid based testing has demonstrated that viruses are a common, yet often undetected, cause of acute gastroenteritis. The development of multiplex pathogen PCR panels makes it possible to detect these viral pathogens with greater sensitivity and rapidity than with previous methods. At present, there is insufficient evidence to recommend the routine use of these panels for the average patient with acute gastroenteritis. However, there are specific scenarios and patient populations such as epidemiology/outbreak surveillance, antimicrobial stewardship, and the care of immunocompromised patients where these tests could be clinically useful today. Further research on the effect of these syndromic panels on provider antibiotic prescribing behavior and patient length of stay will be necessary in order to know their ultimate role in clinical practice.
Mpox represents a diagnostic challenge due to varied clinical presentations and multiple mimics. A commercially available multiplex PCR panel accurately detects mpox virus as well as common mimics (HSV, VZV) in clinical specimens and could be used in routine clinical, surveillance, and outbreak settings.
We assessed the prevalence of antibiotic prescriptions among ambulatory patients tested for coronavirus disease 2019 (COVID-19) in a large public US healthcare system and found a low overall rate of antibiotic prescriptions (6.7%). Only 3.8% of positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) tests were associated with an antibiotic prescription within 7 days.
Background
Nasopharyngeal qualitative RT-PCR is the gold standard for diagnosis of SARS-CoV-2 infection, but not practical or sufficient in every clinical scenario due to its inability to distinguish active from resolved infection. Alternative or adjunct testing may be needed to guide isolation precautions and treatment in hospitalized patients.
Methods
We performed a single-center, retrospective analysis of residual clinical specimens and medical record data to examine blood plasma nucleocapsid antigen as a candidate biomarker of active SARS-CoV-2. Adult patients admitted to the hospital or presenting to the emergency department with SARS-CoV-2 RNA detected by RT-PCR from a nasopharyngeal swab specimen were included. Both nasopharyngeal swab and a paired whole blood sample were required to be available for analysis.
Findings
54 patients were included. 8 patients had positive nasopharyngeal swab virus cultures of which 7 (87·5%) had concurrent antigenemia. 19 (79·2%) of 24 patients with detectable sub-genomic RNA and 20 (80·0%) of 25 patients with N2 RT-PCR Ct ≤ 33 had antigenemia.
Interpretation
Most individuals with active SARS-CoV-2 infection are likely to have concurrent antigenemia, but there may be some individuals with active infection in whom antigenemia is not detectable. The potential for high sensitivity and convenience of a blood test prompts interest in further investigation as a screening tool to reduce reliance on nasopharyngeal swab sampling and as an adjunct diagnostic test to aide in clinical decision making during the period following acute COVID-19.
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