COVID-19 Coronavirus: Is Infection along with <i>Mycoplasma</i>or Other Bacteria Linked to Progression to a Lethal Outcome?

Most patients with COVID-19 disease caused by the SARS-CoV-2 virus recover from this infection, but a significant fraction progress to a fatal outcome. As with some other RNA viruses, co-infection or activation of latent bacterial infections along with pre-existing health conditions in COVID-19 disease may be important in determining a fatal disease course. Mycoplasma spp. (M. pneumonaie, M. fermentans, etc.) have been routinely found as co-infections in a wide number of clinical conditions, and in some cases this has progressed to a fatal disease. Although preliminary, Mycoplasma pneumoniae has been identified in COVID-19 disease, and the severity of some signs and symptoms in progressive COVID-19 patients could be due, in part, to Mycoplasma or other bacterial infections. Moreover, the presence of pathogenic Mycoplasma species or other pathogenic bacteria in COVID-19 disease may confer a perfect storm of cytokine and hemodynamic dysfunction, autoimmune activation, mitochondrial dysfunction and other complications that together cannot be easily corrected in patients with pre-existing health conditions. The positive responses of only some COVID-19 patients to antibiotic and anti-malaria therapy could have been the result of suppression of Mycoplasma species and other bacterial co-infections in subsets of patients. Thus it may be useful to use molecular tests to determine the presence of pathogenic Mycoplasma species and other pathogenic bacteria that are commonly found in atypical pneumonia in all hospitalized COVID-19 patients, and when positive results are obtained, these patients should treated accordingly in order to improve clinical responses and patient outcomes.

Portuguese Society of Intensive Care Score for Predicting SARS-CoV-2 Infection Applied to Inpatients with Pneumonia: A Reliable Tool?

Objectives: Early identification of patients with the novel coronavirus induced-disease 2019 (COVID-19) and pneumonia is currently challenging. Few data are available on validated scores predictive of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The Portuguese Society of Intensive Care (PSIC) proposed a risk score whose main goals were to predict a higher probability of COVID-19 and optimize hospital resources, adjusting patients’ intervention. This study aimed to validate the PSIC risk score applied to inpatients with pneumonia. Methods: A retrospective analysis of 207 patients with pneumonia admitted to a suspected/confirmed SARS-CoV-2 infection specialized ward (20/03 to 20/05/2020) was performed. Score variables were analyzed to determine the significance of the independent predictive variables on the probability of a positive SARS-CoV-2 rRT-PCR test. The binary logistic regression modeling approach was selected. The best cut-off value was obtained with the Receiver Operating Characteristic (ROC) curve together with the evaluation of the discriminatory power through the Area Under the Curve (AUC). Results: The validation cohort included 145 patients. Typical chest computed-tomography features (OR, 12.16;95% CI, 3.32 - 44.50) and contact with a positive SARS-CoV-2 patient (OR, 6.56;95% CI, 1.33 - 32.30) were the most significant independent predictive variables. A score ≥ 10 increased suspicion for SARS-CoV-2 pneumonia. The AUC was 0.82 (95% CI, 0.73 - 0.91) demonstrating the good discriminating power for COVID-19 probability stratification in inpatients with pneumonia. Conclusions: The application of the PSIC score to inpatients with pneumonia may be of value in predicting the risk of COVID-19. Further studies from other centers are needed to validate this score widely.

Physical activity lowers the risk for acute respiratory infections:Time for recognition

Physical inactivity is a well-established risk factor for chronic diseases,such as cardiovascular disease,cancer,and diabetes mellitus.There is a growing awareness that physical inactivity should also be regarded as a risk factor for acute respiratory infections(ARIs).ARIs,such as the common cold,influenza,pneumonia,and coronavirus disease 2019(COVID-19),are among the most pervasive diseases on earth and cause widespread morbidity and mortality.Evidence in support of the linkage between ARIs and physical inactivity has been strengthened during the COVID-19 pandemic because of increased scientific scrutiny.Large-scale studies have consistently reported that the risk for severe COVID-19 outcomes is elevated in cohorts with low physical activity and/or physical fitness,even after adjusting for other risk factors.The lowered risk for severe COVID-19 and other ARIs in physically active groups is attributed to exercise-induced immunoprotective effects,including enhanced surveillance of key immune cells and reduced chronic inflammation.Scientific consensus groups,including those who submitted the Physical Activity Guidelines for Americans,have not yet given this area of research the respect that is due.It is time to add“reduced risk for ARIs”to the“Exercise is Medicine”list of physical activity-related health benefits.

2019—2023年急性呼吸道感染儿童肺炎支原体流行病学特征分析:一项单中心回顾性研究

目的 探讨上海单中心COVID-19大流行前、中、后期急性呼吸道感染(ARTI)患儿肺炎支原体(MP)及其他病原体阳性率的变化。方法 回顾性分析2019年1月1日至2023年12月30日在上海交通大学医学院附属新华医院行呼吸道五联检和流感病毒三联检的ARTI患儿的临床资料。结果 共纳入ARTI患儿91 825例次,男48 729例次、女43 096例次,中位年龄为5.0(3.0~8.0)岁。疫情前组14 096例次,呼吸道病原体阳性5 126例次(36.4%);疫情中组13 366例次,阳性2 963例次(22.2%);疫情后组64 363例次,阳性33 510例次(52.1%)。疫情前、中、后组ARTI患儿之间男性比例、年龄分布、各病原体阳性率差异均有统计学意义(P<0.05);疫情前和疫情后组>6岁患儿比例较高,而疫情中组0~3岁比例较高(P<0.014)。2019—2023年不同年份以及不同月份之间MP阳性率差异均有统计学意义(P<0.05);2019年1、2、12月的MP阳性率较高(20.3%~37.7%),2020年1~3月阳性率较高(21.5%~35.3%),2021年仅12月阳性率(25.8%)高于20.0%,2022年1年的阳性率均低于20.0%,2023年4~6月、8~12月的阳性率均较高(21.5%~37.2%)。MP阳性患儿23 247例次,疫情前、中、后组之间性别、年龄分布差异均有统计学意义(P<0.05);疫情前和疫情后组MP阳性患儿中>6岁比例较高,疫情中组0~3岁比例较高(P<0.014)。结论 在2019—2023年期间,以MP为代表的各种ARTI相关病原体的流行病学特征发生了一定变化,MP的好发年龄分布和季节流行病学特征发生了显著改变。

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.

介入手术室空气压力设计与COVID-19感染控制探讨

目的探讨如何避免COVID-19在介入手术室交叉感染。方法2020年2月7至28日对国内16个省、市、自治区68所三级医院介入手术室净化空调系统空气压力设计情况进行调查,结合介入手术实际及COVID-19防控现状进行分析。结果68所医院介入手术室净化空调系统均无空气负压设计,不具备呼吸道传染病专业防护条件。结论疫情期间增强防控风险意识、加强医疗环境管理、强化感染防护措施、筹划改造、扩建及新建负压介入手术室,有助于降低COVID-19在介入手术室交叉感染风险。

COVID-19疫情防控措施对肺炎克雷伯菌的分布及耐药性的影响

目的了解呼吸与危重症医学科新型冠状病毒肺炎(COVID-19)疫情前后肺炎克雷伯菌(KP)分布状况、耐药KP检出比例及耐药性变化趋势,为临床合理使用抗生素和病原菌耐药性研究提供科学依据。方法应用WHONET 5.6软件收集并首次分析了疫情前(2019年1月~12月)及疫情常态化防控后(2020年5月~2021年4月)成都大学附属医院呼吸与危重症医学科病原微生物培养的样本,比较分析疫情前后样本来源KP菌株、耐药KP检出率,耐药KP对常见抗感染药物耐药性检出差异。结果新冠疫情前1年内及疫情常态化防控1年中样本来源均以痰液/支气管液为主;常态化防控后1年各种标本中KP的分离比例较防控前显著上升(P<0.05)。疫情前1年KP耐药前五位抗生素为氨曲南(26.39%)、头孢他啶(26.39%)、头孢噻肟(25.46%)、氨苄西林/舒巴坦(24.54%)、复方新诺明(18.06%);疫情常态化防控后1年检出耐药KP前五位的抗生素为头孢噻肟(29.78%)、氨曲南(29.21%)、头孢他啶(29.21%)、氨苄西林/舒巴坦(25.84%)、环丙沙星(16.29%)、厄他培南(16.29%)。疫情前后比较,对复方新诺明耐药率显著下降(均P<0.05)。常态化防控前后产ESBL肺炎克雷伯菌耐药率差异无统计学意义(均P>0.05)。结论COVID-19疫情的发生导致KP检出情况及耐药性均发生了变化,应引起临床高度重视,疫情常态化防控期间应对KP感染采取精准积极的干预措施,加强KP检出患者的管理并合理选用抗生素,减少耐药KP的产生与传播。

COVID-19医疗队驻地感染防控经验总结

自2019年12月以来,数百支医疗队4万多名医务人员紧急驰援湖北,抗击新型冠状病毒感染。预防医务人员感染性职业暴露,是保持医疗救治持久力,夺取战疫工作最终胜利的关键。医疗队驻地的感染防控管理是避免医务人员感染性职业暴露重要措施之一。本文就重庆市第八批援鄂医疗队驻地感染防控经验予以总结,以期为类似应急事件感染防控提供参考。

COVID-19发病首周胸部HRCT表现对疾病进展的预测价值

目的探讨新型冠状病毒肺炎(COVID-19)病人发病首周胸部高分辨力CT(HRCT)表现对疾病进展的预测价值。方法回顾性分析67例确诊COVID-19病人发病首周胸部HRCT影像及临床资料,男38例,女29例,平均(49.6±17.6)岁,根据病人病程进展情况分为疾病缓解组[55例,平均年龄(46.1±16.7)岁]和疾病进展组[12例,平均年龄(65.6±12.3)岁]。比较2组的一般临床资料及CT影像特征,分别采用卡方检验、t检验及Fisher确切概率检验比较性别、年龄及CT征象,采用Mann-Whitney U检验分析实验室检查结果及CT病变范围。采用Logistic回归检验分析差异有统计学意义的因素对于疾病进程的预测能力。结果 67例病人中,62例病人呈多肺叶胸膜下区分布并表现为磨玻璃密度影(GGO)(92.54%),多伴有肺实变(74.63%)及含气支气管征(80.6%);少见小叶核心结节、胸腔积液及心包积液。2组病人性别差异无统计学意义(P>0.05)。与缓解组相比,进展组年龄更大、C反应蛋白(CRP)更高、受累肺叶更多、CT评分更高,更多出现胸膜增厚(均P<0.05),其余CT征象差异均无统计学意义(均P>0.05)。对年龄、CRP、受累肺叶、CT评分和胸膜增厚进行Logistic回归分析显示,病人年龄较大(OR=1.082,95%CI:1.018~1.149;P=0.011)及发病首周HRCT受累肺叶较多(OR=2.716,95%CI:1.086~6.790;P=0.033)是提示病人治疗中临床分型升级的独立影响因素。结论 COVID-19发病首周胸部CT表现具有一定特征,年龄大且受累肺叶多者病程中易发展为重症及危重症。

系统性红斑狼疮患者合并COVID-19后发生肺炎的危险因素

目的探讨系统性红斑狼疮(SLE)患者感染新型冠状病毒(SARS-CoV-2)后发生肺炎的危险因素。方法纳入2022年12月—2023年2月于南昌大学第一附属医院风湿免疫科就诊且完善胸部CT检查并确诊为新型冠状病毒感染(COVID-19)的250例SLE患者。根据患者胸部CT结果分为对照组和肺炎组两组。收集两组患者的人口学数据、临床资料及实验室指标,并评估患者完善胸部CT检查之前的实验室资料。通过计算受试者工作特征(ROC)曲线,确定年龄、C反应蛋白/淋巴细胞(CLR)和系统性免疫炎症指数/清蛋白(SII/ALB)对SLE患者合并COVID-19后是否发生肺炎的诊断能力。结果250例SLE合并COVID-19患者中,188例未发生肺炎(占75.2%),为对照组;62例发生肺炎(占24.8%),为肺炎组。两组在年龄、是否接种新冠疫苗、是否合并肾功能不全、是否合并心血管疾病、是否合并糖尿病、中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)、淋巴细胞/单核细胞(LMR)、系统性免疫炎症指数(SII)、SII/ALB和CLR等方面比较,差异有统计学意义(均P<0.05)。在合并COVID-19后发生肺炎的SLE患者中,SII/ALB和CLR水平高于未发生肺炎患者,差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,年龄、SII/ALB和CLR是SLE患者发生新型冠状病毒肺炎的独立危险因素(均P<0.05)。ROC曲线分析显示,CLR曲线下面积为0.791,其灵敏度为90.3%,特异度为57.4%,有良好的诊断价值。结论年龄、SII/ALB和CLR是SLE患者合并COVID-19后发生肺炎的危险因素。对于具备这些特征的人群,临床上需要给予更多的关注,以期减少并发症的发生及改善预后。

流感与COVID-19患者的免疫球蛋白G糖基化差异

The essential role of immunoglobulin G(IgG)in immune system regulation and combatting infectious diseases cannot be fully recognized without an understanding of the changes in its N-glycans attached to the asparagine 297 of the fragment crystallizable(Fc)domain that occur under such circumstances.These glycans impact the antibody stability,half-life,secretion,immunogenicity,and effector functions.Therefore,in this study,we analyzed and compared the total IgG glycome—at the level of individual glycan structures and derived glycosylation traits(sialylation,galactosylation,fucosylation,and bisecting Nacetylglucosamine(GlcNAc))—of 64 patients with influenza,77 patients with coronavirus disease 2019(COVID-19),and 56 healthy controls.Our study revealed a significant decrease in IgG galactosylation,sialylation,and bisecting GlcNAc(where the latter shows the most significant decrease)in deceased COVID19 patients,whereas IgG fucosylation was increased.On the other hand,IgG galactosylation remained stable in influenza patients and COVID-19 survivors.IgG glycosylation in influenza patients was more time-dependent:In the first seven days of the disease,sialylation increased and fucosylation and bisecting GlcNAc decreased;in the next 21 days,sialylation decreased and fucosylation increased(while bisecting GlcNAc remained stable).The similarity of IgG glycosylation changes in COVID-19 survivors and influenza patients may be the consequence of an adequate immune response to enveloped viruses,while the observed changes in deceased COVID-19 patients may indicate its deviation.

Global prevalence,mortality,and main risk factors for COVID-19 associated pneumocystosis:A systematic review and meta-analysis

Objective:Pneumocystis pneumonia(PcP)is a life-threatening infection caused by the opportunistic fungi Pneumocystis jirovecii.The emergence of the COVID-19 pandemic forced the focus of attention of health policymakers on these two infections due to their clinical and paraclinical similarities,which cause diagnostic dilemmas.This study was undertaken to evaluate and estimate the global prevalence and main leading risk factors of coronavirus-associated pneumocystosis(CAP).Methods:We searched related databases between December 2019 and May 2022 for studies reporting CAP.Meta-analysis was performed using StatsDirect software(version 2.7.9)according to the DerSimonian and Laird method applying the random-effects model.We evaluated heterogeneity using theχ2-based Q statistic(significant for P<0.05)and the I2 statistic(>75%indicative of“notable”heterogeneity).Moreover,an odds ratio(OR)analysis was performed for eligible data.Results:Our meta-analysis included eight studies with 923 patients hospitalized with COVID-19;among them,92 were PcP cases.The overall pooled prevalence of CAP was estimated at 11.5%.The mortality among CAP patients was lower than that of non-PcP patients(OR 1.93;95%CI 0.86-4.31).Long-term corticosteroid therapy(OR 28.22;95%CI 0.54-1480.84)was the most predisposing factor for PcP among COVID-19 patients,followed by pulmonary diseases(OR 1.46;95%CI 0.43-4.98),kidney diseases(OR 1.26;95%CI 0.21-7.49),and acute respiratory destruction syndrome(OR 1.22;95%CI 0.05-29.28).Conclusions:The prevalence of PcP among the COVID-19 population is almost similar to the pre-COVID era.However,PcP-related mortality was decreased by the emergence of the COVID-19 pandemic.Women with COVID-19 are more susceptible to PcP than men.Acute respiratory distress syndrome,kidney diseases,pulmonary diseases,and long-term corticosteroid therapy increased the risk of PcP;however,transplantation and malignancy decreased the risk for PcP among COVID-19 patients.Further retrospective,case-control,prospective,and more precisely systematic review and meta-analysis studies are needed in this field.

新冠病症统一命名的建议

新冠疫情暴发三年多来,国内外出现多种有关新冠病症的名称,如国内有新型冠状病毒肺炎、新型冠状病毒感染等,国外有世卫组织命名的2019冠状病毒病以及倡用的新冠后症状,此外还有长新冠、新冠后综合征、新冠后遗症等较为常见的名称。目前已出现一定的混乱,需要正视。通过辨析,提出取舍意见,认为目前应与世卫组织一致,统一使用2019冠状病毒病、新冠后症状。根据术语学有关要求,同时提出规范名词的建议,为进一步审定新冠病症名称提供参考。

清肺排毒颗粒治疗新型冠状病毒肺炎的回顾性研究及应用前景分析

目的分析早期应用清肺排毒颗粒对轻型新型冠状病毒肺炎患者核酸转阴时间、住院天数及核酸转阴率的影响。方法采取回顾性研究法,收集2022年3月15日—2022年4月22日吉林市第七方舱医院收治的、符合标准的轻型新型冠状病毒肺炎病例资料400例,在第九版诊疗方案的基础上,根据早期是否服用清肺排毒颗粒分为观察组和对照组,各200例。统计分析并比较两组核酸转阴时间、住院总天数及核酸复阳率相关性。结果从核酸转阴率及住院总时长来看,观察组明显优于对照组(P<0.05)。两组核酸复阳率比较,差异无统计学意义(P>0.05)。结论在西医常规治疗基础上,早期应用清肺排毒颗粒,可有效缩短轻型新型冠状病毒肺炎患者的核酸转阴时间及住院天数,对其治疗和预后有着积极的临床意义,对日后疫病防治具有一定参考价值。

医疗机构新型冠状病毒肺炎防控中的若干问题

新型冠状病毒肺炎是一种新发传染病。本文就新型冠状病毒特性、新型冠状病毒肺炎的流行病学和临床特点,以及感染防控中的若干问题进行探讨,提出医疗机构新型冠状肺炎防控须加强预检分诊,早期识别患者,及时管理传染源;切实落实标准预防措施;接触疑似患者和确诊患者时,采取补充预防措施,预防医务人员感染;培训、监测与督查;采用环境与工程控制措施和加强感染、感控学科建设等。

新型冠状病毒肺炎患者继发感染的危险因素分析

目的探讨新型冠状病毒肺炎(COVID-19)患者继发细菌感染的危险因素。方法回顾性分析天津市海河医院收治的136例COVID-19患者的临床资料,根据临床诊断结果分为继发细菌性肺炎(继发感染组,44例)和非继发感染组(92例)。比较2组患者临床特征、治疗、疾病转归等差异,Logistic回归分析患者继发感染的危险因素。结果继发感染组患者年龄、合并基础疾病比例高于非继发感染组(P<0.01),入院的氧合指数(OI)<400 mmHg、高热(体温>39℃)、重症、合并急性呼吸窘迫综合征(ARDS)、低蛋白血症、心功能不全比例也均高于非继发感染组,接受机械通气治疗、有创操作、激素治疗比例及住院时间均高于非继发感染组(P<0.05)。Logistics回归分析显示,合并基础疾病(OR=4.613,95%CI:1.756~12.118)、激素治疗(OR=2.403,95%CI:1.012~6.422)、入院OI<400 mmHg(OR=6.534,95%CI:2.064~20.691)、低蛋白血症(OR=12.949,95%CI:3.284~51.067)是继发细菌感染的独立危险因素。结论COVID-19继发感染与患者入院氧合指数低于400 mmHg、低蛋白血症、激素治疗、基础疾病关系密切,临床尽早干预可预防患者继发感染,有利于改善预后。

抗击新型冠状病毒肺炎一线护理人员防护暴露风险事件调查

目的:调查抗击新型冠状病毒肺炎(corona virus disease 2019,COVID-19)一线护士防护暴露风险事件现状,为管理者做好护理人员防护提供依据。方法:便利选取支援武汉的308名护理人员,采用研究团队自行编制的网络问卷进行调查,通过事件回顾的方式对护理人员在防护状态下的7种防护暴露风险事件进行调查。结果:共有304人填写了有效问卷,88.8%的护理人员接受了防护暴露风险事件预防与应对的培训。7种防护暴露风险事件中,鞋套污染、脱落的发生率相对较高,为53.6%;由于有手套的保护,手部或皮肤污染发生率相对较低,为14.1%;护士心理负担最重的防护暴露风险事件是N95口罩污染、脱落或移位,分值达8.2±2.3。单因素分析发现,支援武汉天数不同,防护风险事件发生的种类数量不同(χ^2=14.562,P=0.024);多元有序Logistic回归发现,男性是防护暴露风险事件发生的种类数量的独立保护因素(P=0.019)。结论:支援武汉的一线护理人员工作中会出现防护暴露风险事件,在工作中既要指导护士防止风险事件的发生,又要指导其有效应对,从而减轻心理负担。

新冠肺炎医疗队驻地感染防控探讨

新型冠状病毒肺炎在武汉及周边地区出现了大量的病例,为做好救治工作,全国万名以上医务人员组成医疗队驰援湖北承担病例的诊治工作。医务人员是感染的高风险人群,做好医务人员驻地感染防控的管理,防止在驻地发生感染传播事件是援鄂医疗队防控工作中的重要环节。本文从管理要求、个人清洁与物品消毒、生活中的感染防控、环境消毒与空气净化等方面做了探讨。

新型冠状病毒肺炎临床及影像学研究进展

近期暴发的新型冠状病毒肺炎(novel coronavirus pneumonia,NCP)主要引起呼吸道感染,严重时出现全身各系统并发症,甚至死亡,严重威胁全球公共卫生安全。由于NCP具有传染性较强、人群普遍易感等特点,正确认识其临床及影像学特点对临床诊治和管理具有重要意义。本文就新型冠状病毒肺炎的病原学、流行病学、临床诊治等方面研究进展作一综述,特别对其不同分期CT影像学特征进行分析。

新冠肺炎疫情下入院患者实施胸部CT筛查价值初探

目的探讨新冠肺炎疫情下入院患者实施胸部CT筛查的价值。方法采用回顾性研究。收集2020年2月3日至2020年3月19日于某综合医院完成入院患者胸部CT筛查的影像信息,共纳入1370例,并采集2019年2月14日至2019年4月1日完成入院患者胸部X线检查的影像信息,共纳入2193例。对CT与X线检出的疾病种类、疾病检出率进行分析,并用χ^2检验比较CT与X线对肺内疾病与肺炎检出率的组间差异。结果1370例患者入院胸部CT检查阳性率为94.5%;肺内病变检出率为90.2%;肺炎占检出的肺内疾病的55.2%;可疑病毒性肺炎占3.5%。2019年同期2193例入院患者胸部X线检查阳性率为53.7%;肺内病变占42.2%;肺炎占肺内疾病的26.6%。组间比较显示胸部CT对肺内病变(χ^2=764.2,P<0.001)及肺炎(χ^2=681.8,P<0.001)检出率明显高于X线。结论入院胸部CT筛查能及时高效地检出可疑病毒性肺炎,在新冠肺炎疫情下对疑似病例的“早发现、早隔离”及遏制院内感染至关重要。