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.

Abstract

BACKGROUND:

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.

METHODS:

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.

FINDINGS:

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.

INTERPRETATION:

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.

FUNDING:

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

FULL TEXT

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930183-5

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.

Abstract

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.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973342/pdf/mm6901a2.pdf

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 …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp2000929?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp2000929?articleTools=true

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.)

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMoa2001017?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2001017?articleTools=true

January 29, 2020 at 8:29 am

EDITORIAL – Another Decade, Another Coronavirus

New England J of Medicine January 24, 2020

Perlman

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% (https://promedmail.org/. opens in new tab) …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMe2001126?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMe2001126?articleTools=true

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.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/26/2/19-0697_article?deliveryName=DM17906

PDF (CLIC en DOWNLOAD ARTICLE)

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.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/26/2/19-1221_article?deliveryName=DM17905

PDF (CLIC en DOWNLOAD ARTICLE)

January 27, 2020 at 8:00 am

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