Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases

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Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate, and capacity to overwhelm healthcare systems [1, 2]. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission [3–5].

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Most cited references 10

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

Xiao-Wei Xu, Xiao-Xin Wu, Xian-Gao Jiang … (2020)

Abstract Objective To study the clinical characteristics of patients in Zhejiang province, China, infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease 2019 (covid-2019). Design Retrospective case series. Setting Seven hospitals in Zhejiang province, China. Participants 62 patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection. Data were collected from 10 January 2020 to 26 January 2020. Main outcome measures Clinical data, collected using a standardised case report form, such as temperature, history of exposure, incubation period. If information was not clear, the working group in Hangzhou contacted the doctor responsible for treating the patient for clarification. Results Of the 62 patients studied (median age 41 years), only one was admitted to an intensive care unit, and no patients died during the study. According to research, none of the infected patients in Zhejiang province were ever exposed to the Huanan seafood market, the original source of the virus; all studied cases were infected by human to human transmission. The most common symptoms at onset of illness were fever in 48 (77%) patients, cough in 50 (81%), expectoration in 35 (56%), headache in 21 (34%), myalgia or fatigue in 32 (52%), diarrhoea in 3 (8%), and haemoptysis in 2 (3%). Only two patients (3%) developed shortness of breath on admission. The median time from exposure to onset of illness was 4 days (interquartile range 3-5 days), and from onset of symptoms to first hospital admission was 2 (1-4) days. Conclusion As of early February 2020, compared with patients initially infected with SARS-Cov-2 in Wuhan, the symptoms of patients in Zhejiang province are relatively mild.

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Author and article information

Journal

Journal ID (nlm-ta): Eur Respir J

Journal ID (iso-abbrev): Eur. Respir. J

Journal ID (publisher-id): ERJ

Journal ID (hwp): erj

Title: The European Respiratory Journal

Publisher: European Respiratory Society

ISSN (Print): 0903-1936

ISSN (Electronic): 1399-3003

Publication date (Electronic): 26 May 2020

Publication date PMC-release: 26 May 2020

Electronic Location Identifier: 2001398

Affiliations

[1 ]Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy

[2 ]TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy

[3 ]Tuberculosis Research Programme (PII-TB), SEPAR, Barcelona, Spain

[4 ]Centre Hospitalier Universitaire, Nantes, France

[5 ]Moscow Research and Clinical Center for TB Control, Moscow, Russian Federation

[6 ]The University of Sydney, Sydney Pharmacy School, Sydney, New South Wales, Australia

[7 ]Westmead Hospital, Sydney, Australia

[8 ]Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia

[9 ]Service de Pneumologie CHU AMIENS PICARDIE, France AND UR Université de Picardie Jules Verne, Amiens, France

[10 ]Service de Pneumologie, Clinique Saint Luc, Bouge, Belgium

[11 ]Department of Internal Medicine, Lausanne University, Lausanne, Switzerland

[12 ]Servicio Neumología, Vall D'Hebron University Hospital, Barcelona, Spain

[13 ]Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy

[14 ]Public Health Consulting Group, Lugano, Switzerland

[15 ]Servicio de Enfermedades Infecciosas y Microbiología, Hospital Virgen Macarena, Sevilla, Spain

[16 ]Service de Pneumologie, Groupe hospitalier sud île de France (GHSIF), Melun, France

[17 ]Centre Hospitalier de Bligny, Briis Sous Forges, France

[18 ]Service de Médecine interne, CHI de Créteil, France

[19 ]Pediatric Infectious Diseases Unit, Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Italy

[20 ]Translational Research Unit, National Institute for Infectious Diseases ‘L. Spallanzani’, IRCCS, Rome, Italy

[21 ]Centre de Lutte Antituberculeuse (CLAT 38), Grenoble, France

[22 ]Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases ‘L. Spallanzani’, IRCCS, Rome, Italy

[23 ]Hôpital Européen de Paris La Roseraie, Aubervilliers, France

[24 ]Servicio Neumología, Hospital General Universitario de Castellón, Spain

[25 ]Pulmonary Division, Lausanne University Hospital CHUV, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

[26 ]Dipartimento di Scienze Mediche, Clinica Universitaria Malattie Infettive, Ospedale Amedeo di Savoia, Torino, Italia

[27 ]Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

[28 ]Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, Singapore

[29 ]Hôpital d'Instruction des Armées (HIA) Percy, Clamart, France

[30 ]Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil

[31 ]Infectious Diseases Department, International Health and Tuberculosis Unit, Vall d'Hebron University Hospital, Spain

[32 ]Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain

[33 ]Grupo de Estudio de Infecciones por Micobacterias (GEIM), Spanish Society of Infectious Diseases (SEIMC), Spain

[34 ]Unit of Infectious Diseases, Università Vita e Salute, San Raffaele Hospital, Milan, Italy

[35 ]Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France

[36 ]Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy

[37 ]Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy

[38 ]Servicio Neumología, Hospital de Cruces, Bilbao, Spain

[39 ]Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

[40 ]Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK

[41 ]Department of Infectious Diseases, University of Milan, L. Sacco Hospital, Milan, Italy

[42 ]Servicio Neumología Hospital Universitario Marqués de Valdecilla, Santander, Spain

[43 ]Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy

[44 ]Co-first authors

Author notes

Giovanni Battista Migliori, Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Via Roncaccio 16, Tradate, Varese, 21049, Italy. E-mail: giovannibattista.migliori@ 123456icsmaugeri.it