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Background: Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. Methods and Findings: Retrospective cohort study of patients with confirmed SARS-CoV-2 discharged alive from five hospitals in New York City with index hospitalization between February 27th-April 12th, 2020, with follow-up of ≥14 days. Significance was defined as P<0.05 after multiplying P by 125 study-wide comparisons. Of 2,864 discharged patients, 103 (3.6%) returned for emergency care after a median of 4.5 days, with 56 requiring inpatient readmission. The most common reason for return was respiratory distress (50%). Compared to patients who did not return, among those who returned there was a higher proportion of COPD (6.8% vs 2.9%) and hypertension (36% vs 22.1%). Patients who returned also had a shorter median length of stay (LOS) during index hospitalization (4.5 [2.9,9.1] vs. 6.7 [3.5, 11.5] days; Padjusted=0.006), and were less likely to have required intensive care on index hospitalization (5.8% vs 19%; Padjusted=0.001). A trend towards association between absence of in-hospital anticoagulation on index admission and return to hospital was also observed (20.9% vs 30.9%, Padjusted=0.064). On readmission, rates of intensive care and death were 5.8% and 3.6%, respectively. Conclusions: Return to hospital after admission for COVID-19 was infrequent within 14 days of discharge. The most common cause for return was respiratory distress. Patients who returned had higher proportion of COPD and hypertension with shorter LOS on index hospitalization, and a trend towards lower rates of in-hospital treatment-dose anticoagulation. Future studies should focus on whether these comorbid conditions, longer LOS and anticoagulation are associated with reduced readmissions.

The aim of this study was to determine the frequency and factors associated with Toxoplasma gondii in naturally infected equids in northeastern Brazil. Serum samples from 569 equids (528 horses, 8 mules and 33 donkeys) were subjected to the indirect fluorescent antibody test. Generalized linear models were used to evaluate associated factors. Among the 569 animals sampled, 118 (30.6%) living in rural areas and 14 (26.42%) in urban areas were seropositive (p>0.05). Seropositive animals were observed on 95% of the farms and in all the municipalities. Donkeys/mules as the host, presence of domestic cats and rats on the farm, ingestion of lagoon water and goat rearing remained in the final model as factors associated with infection. Preventive measures such as avoiding the presence of domestic cats close to rearing areas, pastures and sources of water for the animals should be adopted. The wide-ranging distribution of positive animals also indicated that infection in other domestic animals and in humans, through the contaminated environment, was possible. It should be highlighted that there was the possibility that donkeys and mules would continue to have detectable titers for longer, thus explaining the prevalence found. Further studies are needed to confirm this possibility.

Considering the importance and severity of feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) infections, information on laboratory abnormalities can determine the prognosis of infected cats. This study aimed to determine the laboratory alterations of domiciled asymptomatics cats naturally infected by FIV and/or FeLV in Northeastern Brazil. Blood samples from 200 cats were evaluated by nested-PCR and commercial immunochromatographic test for diagnosis of these infections. Complete blood count (CBC) and serum biochemistry analyses were performed to evaluate laboratory abnormalities. CBC and biochemical values of cats tested positive for FIV and/or FeLV were tabulated for the presence or absence of changes and analyzed using the chi-square test with Yates correction or Fisher's exact test for each variable, with a confidence interval of 95%. The total frequency was 6% (12/200) and 3% (6/200) for FIV and FeLV, respectively. The presence of hyperbilirubinemia (total, direct, and indirect) was the only change observed in cats positive for FIV compared to FIV-negative controls (p<0.05). We believe that laboratory changes compatible with immunosuppressive conditions should be more frequent in FIV/FeLV positive cats that already present clinical signs of the disease.

The aim of this study was to determine the frequency and factors associated to Babesia caballi, Theileria equi and Trypanosoma evansi in naturally infected equids from the northeast Brazil. Blood samples from 569 equids (528 horses, 8 mules, and 33 donkeys) were collected and tested for the presence of DNA of each of these protozoan parasites by PCR. Generalized linear models were used to evaluate risk factors associated with the infection. The frequency of T. equi infection was 83.5% (475/569) - 84.3% in horses, and 73.2% in donkeys and mules. The results of the final model indicated that age (senior group) and animal species (mule and donkey group) were protective factors against this pathogen. The frequency of B. caballi infection was 24.3% (138/569) - 23.5% in horses and 34.1% in donkeys and mules. Age (adult and senior group) was considered a protective factor against B. caballi infection whereas animal species (donkey and mule group) were considered a risk factor for the infection. Trypanosoma evansi infection was not detected in any of animals. Our results suggest that equids from the area studied may be infected earlier in life with the etiological agents of equine piroplasmosis and become asymptomatic carriers.

Background Currently, various zoonotic diseases are classified as emerging or reemerging. Because equids have a direct relationship with various vectors, they are possibly more frequently exposed to zoonotic agents than are humans. The undeniable importance of diseases such as human granulocytic anaplasmosis, spotted fever, and leishmaniasis for both public and animal health, as well as the possibility of equids acting as sources, reservoirs, or even sentinels for these pathogens, justifies the detection of their frequency and factors associated with infection in equids from northeastern Brazil. Methods Blood samples were collected from 569 equids (528 horses, 33 donkeys, and 8 mules), 516 from a rural area and 53 from an urban area. Pathogen detection was carried out as follows: Borrelia spp. and Rickettsia spp., serological analysis; Leishmania spp., serological analysis and polymerase chain reaction (PCR); Anaplasma phagocytophilum, PCR. Determination of associated factors was carried out through generalized linear models. Results The frequencies of positivity for the pathogens observed in equids were as follows: Borrelia spp., 13.9% (79/569); Leishmania spp., 3.5% (20/569); Rickettsia spp. 33.4% (190/569). Regarding factors associated with infection, male sex was associated with protection against Borrelia spp.; donkeys and mules were associated with protection against Rickettsia spp., while a younger age was a risk factor. The infection of A. phagocytophilum was not detected in the sampled population. Co-infection was detected in 5.1% (29/569) of the animals. Conclusions Most of the studied pathogenic agents are present in the prospected area, indicating a possible risk for both human and animal health. This demonstrates that equids can be considered important sentinels in the assessment of pathogens with zoonotic potential in the region.

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