Polymerase Chain Reaction Assays Reverted to Positive in 25 Discharged Patients With COVID-19

Yuan, Jing; Kou, Shanglong; Liang, Yanhua; Zeng, Jian; Pan, Yanchao; Liu, Lei

doi:10.1093/cid/ciaa398

Cited by 135 publications

(115 citation statements)

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“…Finally, as a limited number of pediatric patients have been diagnosed in Shenzhen thus far, we have only included adult patients in this study. Effects of obesity on coronavirus infection or disease progression in children are yet to be reported (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…All patients with COVID-19 were carefully treated, and their data were collected by nurses, physicians, or other medical staff at the hospital. There was no missing information for all variables of interest in this study (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). We declare that no data related to obesity and COVID-19 severity from patients in our hospital have been published, submitted, or are in press.…”

Section: Study Design and Participant Criteriamentioning

confidence: 99%

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Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China

et al. 2020

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OBJECTIVE Patients with obesity are at increased risk of exacerbations from viral respiratory infections. However, the association of obesity with the severity of coronavirus disease 2019 (COVID-19) is unclear. We examined this association using data from the only referral hospital in Shenzhen, China. RESEARCH DESIGN AND METHODS A total of 383 consecutively hospitalized patients with COVID-19 admitted from 11 January 2020 to 16 February 2020 and followed until 26 March 2020 at the Third People’s Hospital of Shenzhen were included. Underweight was defined as a BMI <18.5 kg/m2, normal weight as 18.5–23.9 kg/m2, overweight as 24.0–27.9 kg/m2, and obesity as ≥28 kg/m2. RESULTS Of the 383 patients, 53.1% were normal weight, 4.2% were underweight, 32.0% were overweight, and 10.7% were obese at admission. Obese patients tended to have symptoms of cough (P = 0.03) and fever (P = 0.06) compared with patients who were not obese. Compared with normal weight patients, those who were overweight had 1.84-fold odds of developing severe COVID-19 (odds ratio [OR] 1.84, 95% CI 0.99–3.43, P = 0.05), while those who were obese were at 3.40-fold odds of developing severe disease (OR 3.40, 95% CI 1.40–2.86, P = 0.007), after adjusting for age, sex, epidemiological characteristics, days from disease onset to hospitalization, presence of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, liver disease, and cancer, and drug used for treatment. Additionally, after similar adjustment, men who were obese versus those who were normal weight were at increased odds of developing severe COVID-19 (OR 5.66, 95% CI 1.80–17.75, P = 0.003). CONCLUSIONS In this study, obese patients had increased odds of progressing to severe COVID-19. As the severe acute respiratory syndrome coronavirus 2 may continue to spread worldwide, clinicians should pay close attention to obese patients, who should be carefully managed with prompt and aggressive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Study Design and Participant Criteriamentioning

confidence: 99%

Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China

et al. 2020

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“…Furthermore, it is not known if or how ICItherapies affect viral immunity. Recently, cases of COVID-19 reactivation in non-cancer patients have been described 10 . It is possible that release of immune tolerance through administration of a PD-1/PD-L1 inhibitor could permit viral reactivation, or alternatively, cause an unrestrained immunologic attack on a smoldering viral infection.…”

Section: Discussionmentioning

confidence: 99%

Rapidly fatal pneumonitis from immunotherapy and concurrent SARS-CoV-2 infection in a patient with newly diagnosed lung cancer

Lovly

Boyd

González-Ericsson

et al. 2020

Preprint

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Immune checkpoint inhibitors (ICIs) are used for the treatment of numerous cancers, but risks associated with ICI-therapy during the COVID-19 pandemic are poorly understood. We report a case of acute lung injury in a lung cancer patient initially treated for ICI-pneumonitis and later found to have concurrent SARS-CoV-2 infection. Post-mortem analyses revealed diffuse alveolar damage in both the acute and organizing phases, with a predominantly CD68+ inflammatory infiltrate. Serum was positive for anti-SARS-CoV-2 IgG, suggesting that viral infection predated administration of ICI-therapy and may have contributed to a more fulminant clinical presentation. These data suggest the need for routine SARS-CoV-2 testing in cancer patients, where clinical and radiographic evaluations may be non-specific. Case ReportA 56-year-old male with type 2 diabetes, chronic obstructive pulmonary disease, and ongoing tobacco use presented with a one-month history of left-sided chest pain, dyspnea, cough, and sinus congestion but no fevers or chills ( Fig. 1A). His symptoms were refractory to a course of doxycycline. Chest CT revealed a 5 cm spiculated mass in the lingula, mediastinal lymphadenopathy, and multiple liver lesions ( Fig. 1B and data not shown). He was admitted to the hospital for symptom management and to expedite diagnostic studies. Transbronchial biopsy of a subcarinal lymph node revealed small cell lung cancer (SCLC). He was treated with standard therapy for extensive-stage SCLC -carboplatin, etoposide, and atezolizumab (an anti-PD-L1 monoclonal antibody) then discharged on the third day of therapy. He returned to the emergency department within 48 hours with worsening dyspnea and hypoxemia but remained afebrile. Chest CT showed interval development of bilateral ground glass opacities with interlobular septal thickening, most pronounced in the right upper lobe (Fig. 1C), concerning for drug-induced pneumonitis versus infection. He was treated for presumed ICI-pneumonitis (from atezolizumab) with steroids (1g of methylprednisolone for 2 days followed by 1 mg/kg/day prednisone). After 5 days, his respiratory status worsened. Prednisone was increased to 2 mg/kg/day and infliximab (TNFα inhibitor, 5mg/kg) was administered. Repeat CT scan showed progression of the ground glass opacities with a decrease in the left upper lobe tumor mass ( Fig. 1D). He continued to require 10 -15L high-flow oxygen per nasal cannula. He was started on empiric antibiotics (vancomycin and piperacillin/tazobactam) and given one dose of intravenous immunoglobulin (1g/kg). To consider other causes for his declining respiratory status, a SARS-CoV-2 PCR test from a nasal swab was ordered, and the result was positive. Ferritin was 804 ng/mL and LDH was 1218 units/L. Steroids were weaned. His respiratory status continued to worsen, ultimately requiring intubation and mechanical ventilation for hypoxemic respiratory failure. He developed shock requiring vasopressor support. In discussion with his wife, a decision was made to transition to comfort care, ...

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“…Very few cases of prolonged positivity of viral tests and clinical recurrence of COVID-19 have been described [3][4][5][6][7][8]. The case of a 78-year-old woman with COVID-19 possible recurrence in our post-acute and rehabilitation unit prompted us to discuss many issues that we decided to share, as geriatricians may have to face similar dilemmas.…”

Section: Introductionmentioning

confidence: 99%

Possible COVID-19 recurrence in an older patient: a case report

Garnier‐Crussard

Haution

Gueret-Du-Manoir

et al. 2020

Preprint

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Background: Novel coronavirus (COVID-19) pandemic cause by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) threatens the world for few months. Few cases of prolonged positivity of viral tests and clinical recurrence of COVID-19 have been described. We report the case of a 78-year-old woman with metastatic breast cancer who developed possible COVID-19 recurrence in a post-acute and rehabilitation unit. Case presentation: A 78-year-old woman with metastatic breast cancer and hypertension developed COVID-19. After symptom improvement and RT-PCR negativation, she regained symptom (fever, fall) and lymphopenia on Day 26 and we note a turned positive RT-PCR even though she was tested positive for antibody against SARS-CoV-2. After the diagnosis of possible COVID-19 recurrence, she was transferred back to an acute “COVID-19” unit and she then quickly clinically recovered. Conclusions: This clinical case allows us to discuss the risk of recurrence and possible specific causes in older patients. Moreover, prolonged symptoms and lymphopenia could be associated to worse outcomes in older patients. Finally, at a collective level, even if traces of virus detected by RT-PCR were not necessarily correlated with the contagiousness, the importance of possible COVID-19 recurrence in the care pathway for older adults must be taken into account, since they are often surrounded by frail older people.

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Polymerase Chain Reaction Assays Reverted to Positive in 25 Discharged Patients With COVID-19

Cited by 135 publications

References 4 publications

Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China

Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China

Rapidly fatal pneumonitis from immunotherapy and concurrent SARS-CoV-2 infection in a patient with newly diagnosed lung cancer

Possible COVID-19 recurrence in an older patient: a case report

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