Archive for January, 2020

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.

Lancet. January 24, 2020.  

Huang C1, Wang Y2, Li X3, Ren L4, Zhao J5, Hu Y6, Zhang L1, Fan G7, Xu J8, Gu X7, Cheng Z9, Yu T1, Xia J1, Wei Y1, Wu W1, Xie X1, Yin W6, Li H2, Liu M10, Xiao Y4, Gao H11, Guo L4, Xie J5, Wang G12, Jiang R3, Gao Z13, Jin Q4, Wang J14, Cao B15.



A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients.


All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not.


By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα.


The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies.


Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.



January 30, 2020 at 4:24 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications – New York, 2019.

MMWR Morb Mortal Wkly Rep. January 10, 2020 V.69 N.1 P.6-9.  

Ostrowsky B, Greenko J, Adams E, Quinn M, O’Brien B, Chaturvedi V, Berkow E, Vallabhaneni S, Forsberg K, Chaturvedi S, Lutterloh E, Blog D; C. auris Investigation Work Group.


Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1).

Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1).

C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2).

As of June 28, 2019, a total of 801 patients with C. auris were identified in New York, based on clinical cultures or swabs of skin or nares obtained to detect asymptomatic colonization (3).

Among these patients, three were found to have pan-resistant C. auris that developed after receipt of antifungal medications, including echinocandins, a class of drugs that targets the fungal cell wall.

All three patients had multiple comorbidities and no known recent domestic or foreign travel.

Although extensive investigations failed to document transmission of pan-resistant isolates from the three patients to other patients or the environment, the emergence of pan-resistance is concerning.

The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications.

This report summarizes investigations related to the three New York patients with pan-resistant infections and the subsequent actions conducted by the New York State Department of Health and hospital and long-term care facility partners.


January 30, 2020 at 3:42 pm

PERSPECTIVE – A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment

New England J of Medicine January 24, 2020

V.J. Munster and Others

novel coronavirus, designated as 2019-nCoV, emerged in Wuhan, China, at the end of 2019. As of January 24, 2020, at least 830 cases had been diagnosed in nine countries: China, Thailand, Japan, South Korea, Singapore, Vietnam, Taiwan, Nepal, and the United States. Twenty-six fatalities occurred, mainly in patients who had serious underlying illness.1 Although many details of the emergence of this virus — such as its origin and its ability to spread among humans — remain unknown, an increasing number of cases appear to have resulted from human-to-human transmission. Given the severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak in 2002 and the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in 2012 …



January 29, 2020 at 8:30 am

Brief Report – A Novel Coronavirus from Patients with Pneumonia in China, 2019

New England J of Medicine January 24, 2020

Zhu and Others

In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)



January 29, 2020 at 8:29 am

EDITORIAL – Another Decade, Another Coronavirus

New England J of Medicine January 24, 2020


For the third time in as many decades, a zoonotic coronavirus has crossed species to infect human populations. This virus, provisionally called 2019-nCoV, was first identified in Wuhan, China, in persons exposed to a seafood or wet market. The rapid response of the Chinese public health, clinical, and scientific communities facilitated recognition of the clinical disease and initial understanding of the epidemiology of the infection. First reports indicated that human-to-human transmission was limited or nonexistent, but we now know that such transmission occurs, although to what extent remains unknown. Like outbreaks caused by two other pathogenic human respiratory coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]), 2019-nCoV causes respiratory disease that is often severe.1 As of January 24, 2020, there were more than 800 reported cases, with a mortality rate of 3% ( opens in new tab) …



January 29, 2020 at 8:28 am

Perspective – Middle East Respiratory Syndrome Coronavirus Transmission

Emerging Infectious Diseases Journal February 2020 V.26 N.2

Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes a spectrum of respiratory illness, from asymptomatic to mild to fatal.

MERS-CoV is transmitted sporadically from dromedary camels to humans and occasionally through human-to-human contact.

Current epidemiologic evidence supports a major role in transmission for direct contact with live camels or humans with symptomatic MERS, but little evidence suggests the possibility of transmission from camel products or asymptomatic MERS cases.

Because a proportion of case-patients do not report direct contact with camels or with persons who have symptomatic MERS, further research is needed to conclusively determine additional mechanisms of transmission, to inform public health practice, and to refine current precautionary recommendations.



January 27, 2020 at 8:02 am

Research Letter – New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, US

Emerging Infectious Diseases Journal February 2020 V.26 N.2

We report isolation of a New Delhi metallo-β-lactamase-5–producing carbapenem-resistant Escherichia coli sequence type 167 from companion animals in the United States.

Reports of carbapenem-resistant Enterobacteriaceae in companion animals are rare.

We describe a unique cluster of blaNDM-5–producing E. coli in a veterinary hospital.



January 27, 2020 at 8:00 am

Alerta por el novel coronavirus (nCoV) 2019

22/01/2020 – El Ministerio de Salud de Argentina informó que se encuentra realizando un seguimiento de la información epidemiológica brindada por la Organización Mundial de la Salud (OMS) y por los países afectados por la aparición del novel coronavirus 2019 (2019-nCoV), instando a los equipos de salud a fortalecer la vigilancia y las recomendaciones a viajeros para prevenir posibles casos.

Recomendaciones provisorias

Dada que la información disponible a la fecha es parcial, y que la situación epidemiológica es dinámica, el 22 de enero la OMS concretó una reunión del “Comité de Emergencia para neumonía causada por el nuevo coronavirus 2019-nCoV” en el marco del Reglamento Sanitario Internacional (RSI).

El objetivo era evaluar este evento y poner en consideración la declaración de una Emergencia de Salud Pública de Importancia Internacional (ESPII).

Finalizada esta reunión, el Director General de la OMS declaró que se requiere de mayor información y se reevaluará la posición con respecto a la emergencia en una nueva reunión, el día 23 de enero de 2020.

Por estos motivos, las siguientes recomendaciones son de carácter provisorias y dinámicas.

Viajeros internacionales

Al momento, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), no recomienda para este evento ninguna evaluación específica de los pasajeros en los puntos de entrada, ni restricciones sobre viajes o el comercio; sin embargo se recomienda:

  • Promover entre los viajeros la búsqueda de atención médica en el caso que presenten sintomatología compatible con cuadro respiratorio agudo antes, durante, o después de un viaje internacional, especialmente si estuvieron en los países afectados.
  • Promover, entre los viajeros que arriban y salen del país, las buenas prácticas y la conducta para reducir el riesgo general de infecciones respiratorias agudas durante los viajes, tal como toser en el pliegue del codo y la higiene de manos frecuente como acciones fundamentales
  • Específicamente para los viajeros con destino a la ciudad de Wuhan, se recomienda eviten:

– el contacto con individuos que presentan enfermedades respiratorias agudas;

– asistir a lugares con presencia de animales de granja o salvajes, vivos o muertos; e

– ingerir alimentos crudos.

Estas medidas son especialmente importantes en el marco de la celebración del Año Nuevo Chino (que comienza el 25/febrero/2020) por lo que se recomienda reforzar las medidas de prevención mencionadas.

Equipos de salud

La enfermedad provocada por el 2019-nCoV presenta síntomas respiratorios agudos, motivo por el cual se debe registrar en el Sistema Nacional de Vigilancia de la Salud (SNVS 2.0) dentro del grupo de las infecciones respiratorias agudas (IRA); las mismas son eventos de notificación obligatorias, según Ley 15.465. Dentro de estos eventos respiratorios se incluyen las infecciones respiratorias agudas graves (IRAG) y las infecciones respiratorias agudas graves inusitadas (IRAGI); la enfermedad provocada por el 2019-nCoV corresponde a estos eventos.

Los servicios de salud deben notificar de forma inmediata a través del Sistema Nacional de Vigilancia de la Salud todos los casos desde la sospecha y con datos completos.

Definición de caso

  • Caso sospechoso

− Pacientes con IRAG (fiebre, tos y requerimiento de internación) sin otra etiología que explique completamente la   presentación clínica y

– que tenga un historial de viaje o que haya estado en Wuhan, provincia de Hubei, China, en los 14 días anteriores al inicio de   los síntomas; o

– que sea un trabajador de la salud en un entorno que atiende a pacientes con IRAG con etiología desconocida.

− Un paciente con enfermedad respiratoria aguda con cualquier nivel de gravedad que dentro de los 14 días previos al inicio   de la enfermedad tuvo:

– contacto físico cercano con un caso confirmado de infección por 2019-nCoV; ó

– exposición en un centro de salud de un país donde han sido reportadas infecciones por 2019-nCoV asociadas al hospital; ó que haya visitado Wuhan, China.

  • Caso Probable

− Caso sospechoso con prueba positiva para pancoronavirus y negativa para los coronavirus MERS-CoV, 229E, OC43,   HKU1 y NL63.

  • Caso confirmado

− Toda persona con laboratorio confirmado de 2019-nCoV independientemente de cualquier signo o síntoma.


Argentina cuenta con la capacidad de realizar el diagnóstico de pancoronavirus y de diferenciar coronavirus como el del síndrome respiratorio agudo severo (SARS) y el del síndrome respiratorio de Medio Oriente (MERS-CoV), así como los causantes del resfrío común como los tipos 229E, OC43, HKU1 y NL63.


  • Toma de muestras

Los laboratorios deben continuar utilizando el algoritmo de influenza recomendado por la OPS para la vigilancia de influenza de rutina y los casos de IRAG e IRAGI. Las pruebas para el 2019-nCoV deben considerarse solo para pacientes que se ajustan a la definición del caso, una vez que se han descartado influenza e influenza aviar y derivarse a través del componente laboratorio del nuevo SNVS 2.0 y enviadas al Laboratorio Nacional de Referencia y Centro Nacional de Influenza de OMS: Servicio de Virosis Respiratorias, Instituto Nacional de Enfermedades Infecciosas/Administración Nacional de Laboratorios e Institutos de Salud ‘Dr. Carlos Gregorio Malbrán’ (INEI-ANLIS), para que se realice la caracterización viral correspondiente.

Las muestras deben ser recolectadas por personal capacitado y teniendo en cuenta todas las instrucciones de bioseguridad y el equipo de protección personal apropiado para virus respiratorios. Las muestras recomendadas son aquellas del tracto respiratorio bajo, incluyendo esputo, lavado broncoalveolar y aspirado traqueal (cuando sea posible, según los criterios médicos). Sin embargo, cuando no es posible la toma de estas muestras, las del tracto respiratorio alto también son útiles, como ser hisopado nasofaríngeo combinado con un hisopado orofaríngeo (los hisopos deben colocarse y transportarse en el mismo tubo con medio de transporte viral).

Prevención y control de infecciones en ambientes hospitalarios

  • Aplicación de precauciones para todos los casos:

− higiene de manos;

− uso de equipos de protección personal según evaluación de


− toser en el pliegue del codo;

− descarte seguro de materiales cortopunzantes;

− manejo adecuado del ambiente y de los residuos patológicos


− esterilización y desinfección de dispositivos médicos y


− implementación de medidas estrictas de control de infecciones y

de contacto;

− definición de áreas de espera específicas para los pacientes

sintomáticos y ventilación ambiental frecuente y

adecuada   dentro de los establecimientos de salud;

− limpieza del entorno hospitalario; y separación de al menos un

metro de distancia entre los pacientes.


  • Implementación empírica de precauciones adicionales según mecanismo de transmisión:

− instituir las medidas adecuadas para evitar la transmisión por

macrogotas y de contacto frente a casos sospechosos


− instituir precauciones de contacto y de microgotas/aerosoles

cuando se realicen procedimientos tales como

intubación     traqueal, ventilación no invasiva, traqueotomía,

reanimación cardiopulmonar, ventilación manual antes de la

intubación y la  broncoscopia para casos.











January 24, 2020 at 8:04 am

Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices – US 2019

MMWR January 24, 2020 V.69 N.3 P.77–83


What is already known about this topic?

Repeat doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine at 5- and 10-year intervals are safe and immunogenic.

What is added by this report?

ACIP recommendations have been updated to allow either tetanus and diphtheria toxoids (Td) vaccine or Tdap to be used for the decennial Td booster, tetanus prophylaxis for wound management, and for additional required doses in the catch-up immunization schedule if a person has received at least 1 Tdap dose.

What are the implications for public health practice?

Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility.



January 24, 2020 at 7:27 am

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

American Journal of Respiratory and Critical Care Medicine October 1, 2019 V.200 N.7


This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.


A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.


The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.


The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.



January 21, 2020 at 3:54 pm

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