Clinical features and risk factors associated with severe COVID-19 patients in China

Background::Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has rapidly spread throughout the world.In this study,we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.Methods::A multicenter,cross-sectional study was conducted on 313 patients hospitalized with COVID-19.Patients were classified into two groups based on disease severity(nonsevere and severe)according to initial clinical presentation.Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics.Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.Results::A total of 289 patients(197 nonsevere and 92 severe cases)with a median age of 45.0(33.0,61.0)years were included in this study,and 53.3%(154/289)were male.Fever(192/286,67.1%)and cough(170/289,58.8%)were commonly observed,followed by sore throat(49/289,17.0%).Multivariate logistic regression analysis suggested that patients who were aged≥65 years(OR:2.725,95%confidence interval[CI]:1.317-5.636;P=0.007),were male(OR:1.878,95%CI:1.002-3.520,P=0.049),had comorbid diabetes(OR:3.314,95%CI:1.126-9.758,P=0.030),cough(OR:3.427,95%CI:1.752-6.706,P<0.001),and/or diarrhea(OR:2.629,95%CI:1.109-6.231,P=0.028)on admission had a higher risk of severe disease.Moreover,stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19(71.4%vs.28.6%,χ2=8.183,P=0.004).Conclusions::The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different.The elderly,male patients with COVID-19,diabetes,and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

A Pilot Study of Quantitative Loop-mediated Isothermal Amplification-guided Target Therapies for Hospital-acquired Pneumonia

Background： It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia （HAP）, but the traditional culture results always delay the target antibiotic therapy. We assessed the method called quantitative loop-mediated isothermal amplification （qLAMP） as a new implement for steering of the antibiotic decision-making in HAP. Methods： Totally, 76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients. DNA was isolated from these samples. Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay. Culture results of these patients were compared with the qLAMP results. Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data. McNemar test and Fisher＇s exact test were used for statistical analysis. Results： The detection of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Stenotrophomonas maltophilia, Streptococcus pneumonia, and Acinetobacter baumannii by qLAMP was consistent with sputum culture （P 〉 0.05）. The qLAMP results of 4 samples for Haemophilus influenzae, Legionella pneumophila, or Mvcoplasma pneumonia （MP） were inconsistent with culture results; however, clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis. The improvement of clinical condition was more significant （P 〈 0.001） in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy. Conclusion： qLAMP is a more promising method for detection of pathogens in an early, rapid, sensitive, and specific manner than culture.

Genetic factors related to the widespread dissemination of ST11 extensively drug-resistant carbapenemase-producing Klebsiella pneumoniae strains within hospital

Background:Carbapenemase-producing Klebsiella pneumoniae(CP-Kp)poses distinct clinical challenges due to extensively drug resistant(XDR)phenotype,and sequence type(ST)11 is the most dominant blaKPC-2-bearing CP-Kp clone in China.The purpose of this current retrospective study was to explore the genetic factors associated with the success of XDR CP-Kp ST11 strains circulated in the intensive care unit(ICU)of a Chinese tertiary hospital.Methods:Six ST11 XDR CP-Kp strains were identified between May and December 2014 and validated by minimum inhibitory concentration examination,polymerase chain reaction,and pyrosequencing.The six ST11 XDR CP-Kp,as well as three multi-drug resistant(MDR)and four susceptible strains,were sequenced using single-molecule real-time method.Comprehensively structural and functional analysis based on comparative genomics was performed to identify genomic characteristics of the XDR ST11 CP-Kp strains.Results:We found that ST11 XDR blaKPC-2-bearing CP-Kp strains isolated from inpatients spread in the ICU of the hospital.Functionally,genes associated with information storage and processing of the ST11 XDR CP-Kp strains were more abundant than those of MDR and susceptible strains,especially genes correlative with mobile genetic elements(MGEs)such as transposons and prophages.Structurally,eleven large-scale genetic regions taken for the unique genome in these ST11 XDR CP-Kp strains were identified as MGEs including transposons,integrons,prophages,genomic islands,and integrative and conjugative elements.Three of them were located on plasmids and eight on chromosomes;five of them were with antimicrobial resistance genes and eight with adaptation associated genes.Notably,a new blaKPC-2-bearingΔΔTn1721-blaKPC-2 transposon,probably transposed and truncated fromΔTn1721-blaKPC-2 by IS903D and ISKpn8,was identified in all six ST11 XDR CP-Kp strains.Conclusion:Our findings suggested that together with clonal spread,MGEs identified uniquely in the ST11 XDR CP-Kp strains might contribute to their formidable adaptability,which facilitated their widespread dissemination in hospital.

Silent War to Emerging or Re-emerging Respiratory Infection Diseases Badly Kept in Mind

Recently,a man aged 44 years from South Korea who flew to Hong Kong on May 26,subsequently traveled to Huizhou,Guangdong Province,had drawn the worldwide attention.First laboratory-confirmed case of middle east respiratory syndrome （MERS） finally landed in China,3 years after the first identification of MERS coronavirus （MERS-CoV） in Saudi Arabia,2012.In reality actually, MERS did not attract much attention in China till now although we had alerted about the possibility of its importation, or even pandemic. A similar phenomenon has happened in South Korea, lacking of awareness among health care workers and the general public, contributing to suboptimal infection prevention and control measures in health facilities, and finally cause the outbreak of MERS in South Korea and the exported case to China. Fortunately, we have won out in the battle, and no additional cases have been identified among close contacts in China （n = 75）. Meanwhile, we still have lingering fears as there are sporadic infections and outbreaks all over the world.

Lophomonas blattarum Infection or Just the Movement o Ciliated Epithelial Cells？

INTRODUCTION Lophomonas blattarum （L. blattarum） is a multiflagellated protozoan, which parasitizes in the intestinal tracts of termites and cockroaches, belonging to the Lophomonas suborder, Hypermastigida order. More than 100 cases of bronchopulmonary L. blattarum infection have been reported since 1993. However, we identified the movable cells from the bronchoalveolar lavage fluid （BALF） of six patients with pulmonary diseases under an electron microscope, and eventually lbund that these cells were actually bronchial ciliated epithelial cells, which were basically identical with reported L. blattarum in morphology under light microscope in the literature, Through careful literature review, we found that all of the reported L. blattarum infections were just diagnosed by morphology under light microscope rather than electron microscope, isolation and culture, or molecular procedures; images exhibited in these literatures were all compatible with the microscopic characteristics of bronchial ciliated epithelial cells.

Clinical and etiological characteristics of community-acquired pneumonia at high altitudes in Tibet, China

To the Editor:Community-acquired pneumonia(CAP)is one of the most common infectious diseases,causing high morbidity and mortality.High altitudes are characterized by a hypoxic environment with low barometric pressure,increased ultraviolet radiation,and low humidity.Hypoxia can disturb normal homeostasis of the immune system,especially impairing the function of the T lymphocytes,leading to an increased susceptibility to bacterial infection.The respiratory symptoms of CAP at high altitudes are similar to that of high-altitude pulmonary edema.

Feasibility of coronavirus disease 2019 eradication

On March 11,2020,the World Health Organization announced that the current outbreak of coronavirus disease 2019(COVID-19)is a global pandemic.[1]COVID-19,an acute respiratory contagious disease to which all people seem to be susceptible,is caused by 2019 novel coronavirus(2019-nCoV).The patient zero for this pandemic is unknown.Early epidemiology estimates suggest that the basic reproduction number(R0)for COVID-19 is 2.3,with a serial interval of 7.5 days.[2]Chinese doctors and scientists issued warnings of a global pandemic at the initial phase.[3]Unfortunately,the disease spread widely.Outbreaks and numerous new COVID-19 cases are reported daily around the world,causing public panic.To April 18,2020,there have been more than 2,200,000 confirmed cases and 150,000 death cases reported globally.[4]

Lucky China： Efficient Prevention from Middle East Respiratory Syndrome and its Beyond

Middle East respiratory syndrome （MERS） has recently drawn worldwide attention since its nosocomial or suspected community-acquired clusters in South Korea, which has been the largest and the most complex outbreak of the Middle East Region since 2012. It is such a large fortune for China to be able to prevent effectively from MERS, not only by actively monitoring the Korean imported case based on the notification of WHO Western Pacific Region Office （WPRO）, but also by properly quarantining a number of close contacts. Otherwise, China might undergo the same situation as in South Korea, or even worse, if the patient kept on traveling through Southern China or went to health care facilities without wearing any personal preventing equipment. To date, this laboratory-confirmed MERS patient has recovered and been discharged from hospital, and none of the close contacts （n = 75） has showed any associated symptoms, so lucky for him and China.

Combination of Gram Stain, Sputum Culture, and Molecular Method for Diagnosis and Guiding Target Therapies of Bacterial Pneumonia

Dear Prof. Guo, Thank you for your interest in our work. It is important to obtain qualified sputum specimen for accurate etiology diagnosis of bacterial pneumonia. In our study, all specimens were lower respiratory secretion samples, which means all the samples were detected by Gram stain before quantitative loop-mediated isothermal amplification （qLAMP） assay and only adequate samples （sputum containing 〉25 leukocytes per low power field） were enrolled. In fact, most of our samples were lower respiratory tract aspirations by bronchoscopy which were more accurate to reflect the pathogens of pneumonia.

Bronchopulmonary Lophomonas blattarum Infection： Still a Pending Issue

We thank Dr. Martinez-Girdn for the interest in our article about bronchopulmonary Lophomonas blattarum infection .